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Maternal outcomes of pregnant women with asthma exacerbation requiring intensive management in a critical care setting
SMFM Abstracts S87 277 MAGNESIUM SULFATE INHIBITS INFLAMMATORY RESPONSES IN HUMAN UMBILICAL VEIN ENDOTHELIAL CELLS (HUVECS) BURTON ROCHELSON1, OONAGH DOWLING2, CHRISTINE N. METZ2, JEANNE WOODS1, 1North Shore University Hospital, Division of Maternal-Fetal Medicine, Manhasset, New York, 2Institute for Medical Research at North Shore-LIJ, Center for Patient Oriented Research, Manhasset, New York OBJECTIVE: Although it has been used for decades for the treatment of premature labor and seizure prophylaxis in preeclampsia, the exact mechanism of action of magnesium sulfate (MgSO4) has not been definitively elucidated. Aberrant pro-inflammatory cytokine production has been implicated in the etiology of each of these disorders. Our objective was to determine the effect of MgSO4 on human umbilical vein endothelial cell (HuVEC) inflammatory responses by examining its effect on basal and stimulated inflammatory cytokine production and cell adhesion molecule expression in vitro. STUDY DESIGN: Human umbilical vein endothelial cells (HuVECs) were isolated from anonymous umbilical cords using collagenase. Confluent HuVEC monolayers (in M199 media containing 10%FBS) were treated with MgSO4 (1-10 mM) alone or MgSO4 (1-10 mM) followed by LPS (1 ug/ml) 0.5 hr later. After an overnight incubation, (a) cell culture supernatants were collected for IL-8 determination by ELISA and (b) cellular ICAM-1 expression was evaluated using a cell-based ELISA method. Statistical significance was determined by ANOVA followed by Tukey post hoc analysis to make pairwise comparisons. RESULTS: Under basal conditions, MgSO4 had no effect on IL-8 production or ICAM-1 expression by HuVEC cultures. We observed that treatment of HuVECs with MgSO4 (2.5 mM-10 mM) prior to LPS stimulation inhibited IL-8 production, in a dose-dependent manner (25-50% inhibition, p!0.05). Similarly, MgSO4 (2.5-10 mM) treatment suppressed ICAM-1 expression by LPS (25-40% inhibition, p!0.05). MgSO4 was more potent than dexamethasone alone and the combination of dexamethasone C MgSO4 was not additive. MgSO4 was not cytotoxic at the concentrations used. CONCLUSION: MgSO4 inhibits the LPS-induced IL-8 production and ICAM-1 expression by HuVECs. . This suppression of inflammatory cytokine production and expression of ICAM-1 by the endothelium may help to explain the efficacy of magnesium sulfate in preeclampsia and preterm labor. Our ongoing studies focus on investigating the mechanism(s) of action.
279 METHAMPHETAMINE USE DURING PREGNANCY PATRICIA SCOTT1, MARY FLEMING1, KELLY BENNETT1, CORNELIA GRAVES1, 1Vanderbilt University, Obstetrics/ Gynecology, Nashville, Tennessee OBJECTIVE: Methamphetamine is the fastest growing illicit drug in the United States. It is a powerfully addictive stimulant and is produced easily in home laboratories. Methamphetamine use has been associated with adverse events including myocardial infarction and stroke. Outcomes of methamphetamine use during pregnancy are not described in the literature. The purpose of this study is to determine the outcomes in pregnancies exposed to metamphetamine. STUDY DESIGN: A retrospective chart review of all pregnancies associated with substance abuse from 1998 until present at our tertiary care center was undertaken. Pregnant patients with presumptive positive urine drug screen for methamphetamine and metabolites were included. Data were analyzed for adverse maternal and fetal outcomes, including hypertensive complications, prematurity, NICU admissions and maternal or fetal death. RESULTS: Study search criteria was met by 675 patients. Thirty-two records were identified as presumptive positive for methamphetamine and/or metabolites. Results were divided into maternal and neonatal complications. Maternal complications comprised 68.75% (22/32) of the total. Preterm labor affected 21.9% (7/32). Hypertensive complications affected 25% (8/32) of patients: preeclampsia 15.6% (5/32), post-partum preeclampsia 6.25% (2/32), and one hypertensive emergency (1/32). Antepartum hemorrhage complicated 12.5% (4/32). Two maternal deaths occurred in our cohort. Total number of births was 27, with neonatal complications occurring in 70.4% (8/27). Prematurity complicated 51.9% (14/27). Admission to NICU occurred in 48.1% (13/37) with 84.6% (11/13) accounting for preterm neonates. Three neonatal deaths occurred. CONCLUSION: With the increase of methamphetamine use, its effects during pregnancy are more relevant. This study suggests methamphetamine use during pregnancy is associated with significant maternal and fetal morbidity.
278 WITHDRAWN
280 MATERNAL OUTCOMES OF PREGNANT WOMEN WITH ASTHMA EXACERBATION REQUIRING INTENSIVE MANAGEMENT IN A CRITICAL CARE SETTING AMMAR SHAMMAA1, JERRIE REFUERZO1, SEAN BLACKWELL1, YORAM SOROKIN2, 1 Wayne State University, Obstetrics and Gynecology, Detroit, Michigan, 2 Wayne State University, Ob/Gyn/Maternal Fetal Med, Detroit, Michigan OBJECTIVE: The purpose of this study is to determine maternal outcomes of pregnant women with severe acute exacerbation of asthma requiring intensive maternal management. STUDY DESIGN: A retrospective chart review was conducted of admissions to a maternal special care unit (MSCU) due to a severe asthma exacerbation during pregnancy from January 2002 to December 2003. All pregnant women with hypoxia, respiratory distress and/or persistent severe exacerbation of asthma are routinely admitted to the MSCU, a specialized unit that provides intensive maternal management in a critical care setting. Maternal demographics, asthmatic history and clinical characteristics were collected. Furthermore, the hospital course of women with a concomitant diagnosis of pneumonia was compared to those without pneumonia. RESULTS: Of the 1216 admisssions to the MSCU, 2.8% (n=34) were for severe asthma exacerbation. Maternal demographics are as follows: age 30.3 G 7.9 years, African American 94.1%, gestational age 27.8 G 8.6 weeks, BMI 22.8 G 19.3 kg/m2 and smoking 38.2%. Many women had an asthmatic history prior to the onset of pregnancy with 64.7% reporting prior steroid use and 26.5% prior intubation. In the current pregnancy, 44.1% reported recent steroid use and 8.8% were recently intubated. There were 11 admissions (32.4%) with a concomitant diagnosis of pneumonia. These women displayed a longer length of oxygen requirement (5.5 G 4.8 vs 3.2 G 5.1 days, p=0.060), intravenous steroid therapy (4.6 G 4.8 vs. 1.9 G 1.8 days, p=0.201) and total hospital days (8.3G 6.2 vs. 4.8 G 5.2, p=0.071) compared to women without pneumonia. They also had a significantly longer length of time in a critical care setting (5.5 G 4.9 vs. 1.9 G 1.1 days, p=0.021). CONCLUSION: Women requiring a critical care setting for the management of severe asthma exacerbation during pregnancy often have a significant asthmatic history. Prolonged hospital courses are to be expected especially in those women with concomitant pneumonia.
279 METHAMPHETAMINE USE DURING PREGNANCY PATRICIA SCOTT1, MARY FLEMING1, KELLY BENNETT1, CORNELIA GRAVES1, 1Vanderbilt University, Obstetrics/ Gynecology, Nashville, Tennessee OBJECTIVE: Methamphetamine is the fastest growing illicit drug in the United States. It is a powerfully addictive stimulant and is produced easily in home laboratories. Methamphetamine use has been associated with adverse events including myocardial infarction and stroke. Outcomes of methamphetamine use during pregnancy are not described in the literature. The purpose of this study is to determine the outcomes in pregnancies exposed to metamphetamine. STUDY DESIGN: A retrospective chart review of all pregnancies associated with substance abuse from 1998 until present at our tertiary care center was undertaken. Pregnant patients with presumptive positive urine drug screen for methamphetamine and metabolites were included. Data were analyzed for adverse maternal and fetal outcomes, including hypertensive complications, prematurity, NICU admissions and maternal or fetal death. RESULTS: Study search criteria was met by 675 patients. Thirty-two records were identified as presumptive positive for methamphetamine and/or metabolites. Results were divided into maternal and neonatal complications. Maternal complications comprised 68.75% (22/32) of the total. Preterm labor affected 21.9% (7/32). Hypertensive complications affected 25% (8/32) of patients: preeclampsia 15.6% (5/32), post-partum preeclampsia 6.25% (2/32), and one hypertensive emergency (1/32). Antepartum hemorrhage complicated 12.5% (4/32). Two maternal deaths occurred in our cohort. Total number of births was 27, with neonatal complications occurring in 70.4% (8/27). Prematurity complicated 51.9% (14/27). Admission to NICU occurred in 48.1% (13/37) with 84.6% (11/13) accounting for preterm neonates. Three neonatal deaths occurred. CONCLUSION: With the increase of methamphetamine use, its effects during pregnancy are more relevant. This study suggests methamphetamine use during pregnancy is associated with significant maternal and fetal morbidity.
278 WITHDRAWN
280 MATERNAL OUTCOMES OF PREGNANT WOMEN WITH ASTHMA EXACERBATION REQUIRING INTENSIVE MANAGEMENT IN A CRITICAL CARE SETTING AMMAR SHAMMAA1, JERRIE REFUERZO1, SEAN BLACKWELL1, YORAM SOROKIN2, 1 Wayne State University, Obstetrics and Gynecology, Detroit, Michigan, 2 Wayne State University, Ob/Gyn/Maternal Fetal Med, Detroit, Michigan OBJECTIVE: The purpose of this study is to determine maternal outcomes of pregnant women with severe acute exacerbation of asthma requiring intensive maternal management. STUDY DESIGN: A retrospective chart review was conducted of admissions to a maternal special care unit (MSCU) due to a severe asthma exacerbation during pregnancy from January 2002 to December 2003. All pregnant women with hypoxia, respiratory distress and/or persistent severe exacerbation of asthma are routinely admitted to the MSCU, a specialized unit that provides intensive maternal management in a critical care setting. Maternal demographics, asthmatic history and clinical characteristics were collected. Furthermore, the hospital course of women with a concomitant diagnosis of pneumonia was compared to those without pneumonia. RESULTS: Of the 1216 admisssions to the MSCU, 2.8% (n=34) were for severe asthma exacerbation. Maternal demographics are as follows: age 30.3 G 7.9 years, African American 94.1%, gestational age 27.8 G 8.6 weeks, BMI 22.8 G 19.3 kg/m2 and smoking 38.2%. Many women had an asthmatic history prior to the onset of pregnancy with 64.7% reporting prior steroid use and 26.5% prior intubation. In the current pregnancy, 44.1% reported recent steroid use and 8.8% were recently intubated. There were 11 admissions (32.4%) with a concomitant diagnosis of pneumonia. These women displayed a longer length of oxygen requirement (5.5 G 4.8 vs 3.2 G 5.1 days, p=0.060), intravenous steroid therapy (4.6 G 4.8 vs. 1.9 G 1.8 days, p=0.201) and total hospital days (8.3G 6.2 vs. 4.8 G 5.2, p=0.071) compared to women without pneumonia. They also had a significantly longer length of time in a critical care setting (5.5 G 4.9 vs. 1.9 G 1.1 days, p=0.021). CONCLUSION: Women requiring a critical care setting for the management of severe asthma exacerbation during pregnancy often have a significant asthmatic history. Prolonged hospital courses are to be expected especially in those women with concomitant pneumonia.