- Email: [email protected]
124: The risk of stillbirth in breech fetuses stratified by gestational age
Poster Session I
ajog.org the regression model did not include GA and birth weight (aRR 1.8 [CI 1.2-2.8]) but did not persist in the model including GA and birth weight. 5 minute Apgar less than 7 also was more common in the previa group, but only when GA was not included in the regression model (aRR 2.1 [1.3-3.5]). CONCLUSION: More than 11% of neonates delivered to women with previa suffered meaningful morbidity and the mean gestational age at delivery was 35 weeks. Neonatal morbidity associated with previa is primarily associated with gestational age at delivery, rather than placental insufficiency or maternal hemorrhage.
RESULTS: Included in the study 119 CD for PP, that were characterized with lower gestational age, as compared to controls (n¼119),(35.8 4 vs. 38.8 2 weeks, p<0.001). Placentas in the PP group were smaller (P<0.001), with higher rate of placentas <10th% (p<0.001), as compared to controls. Higher rate of vascular lesions related to maternal underperfusion (p¼0.019), vascular and villous lesions consistent with FTOD (p¼0.024, p¼0.049), were detected in the PP group as compared to controls. Higher rate of FGR (p¼0.005), and worse composite neonatal outcome (45.3% vs. 11.8%, p<0.001) were also observed in the PP group as compared to controls. Using a multivariate logistic regression analysis, PP was found to be independently associated with placental maternal origin lesions (OR¼2.48, 95% CI 1.2-4.9, p¼0.009), placental FTOD lesions (OR-7.05, 95% CI 2.4-20.2, p<0.001), placental weight <10th% (OR-6.6, 95% CI 2.7-16.6, p<0.001). FGR was independently associated with PP (OR-10.09, 95% CI 2.3-44.2, p¼0.002). CONCLUSION: Worse neonatal outcome, higher rate of FGR, and higher rate of placental maternal and fetal origin vascular lesions, in pregnancies associated with PP, express underlying placental pathology, probably related to abnormal placentation and placental function.
124 The risk of stillbirth in breech fetuses stratified by gestational age Vanessa R. Lee, Jessica M. Page, Rachel A. Pilliod, Aaron B. Caughey 1 Oregon Health & Science University, Portland, OR, 2University of Utah, Salt Lake City, UT, 3Brigham and Women’s Hospital, Boston, MA
123 Increased placental vascular lesions and neonatal growth restriction characterize pregnancies complicated by placenta previa Eran Weiner, Hadas Miremberg, Ehud Grinstein, Yossi Mizrachi, Letizia Schreiber, Jacob Bar, Michal Kovo 1
Wolfson Medical Center, Holon, Israel
OBJECTIVE: To study the association between neonatal outcome and
placental histopathology lesions in pregnancies complicated by placenta previa (PP). STUDY DESIGN: Pregnancy and neonatal outcomes and placental pathology reports, from cesarean deliveries (CD) of PP (PP group) from 2009 to 2015, were reviewed. Results were compared to elective CD (control group) adjusted for maternal age and diseases. Placental lesions were categorized to vascular and villous lesions related to maternal underperfusion and fetal thromboocclusive disease (FTOD), and maternal and fetal inflammatory responses. Composite neonatal outcome was defined as one or more of early complications: ventilation, NEC, sepsis, transfusion, seizures, phototherapy, or death. FGR was defined as birth-weight < 10th percentile.
OBJECTIVE: We sought to characterize the weekly risk of intrauterine fetal death (IUFD) in breech fetuses compared to fetuses in vertex presentation. STUDY DESIGN: This is a retrospective cohort study of 1,907,052 singleton, nonanomalous pregnancies between 32-42 weeks’ gestation in California from 2005-2008. We calculated the risk of IUFD per 10,000 ongoing pregnancies for breech and vertex fetuses at each week of gestation. We used c2 tests to compare dichotomous variables and multivariate logistic regression to control for potential confounders in our entire cohort, and then calculated gestational age-specific risks using a pregnancies-at-risk life table method. RESULTS: There were 45,771 breech pregnancies and 1,861,281 vertex controls eligible for analysis. In our entire cohort, breech presentation was associated with higher odds of stillbirth with an adjusted odds ratio of 1.3 (95% CI 1.1-1.5) after controlling for maternal age, ethnicity, socioeconomic status, parity, diabetes, hypertensive disease, small-for-gestational age, and amniotic fluid volume disorders. When stratified by gestational age, the risk of stillbirth per 10,000 ongoing pregnancies was significantly higher in breech pregnancies compared to vertex pregnancies at each week of gestation. The risk of stillbirth was as high as 44.8 per 10,000 at-risk breech fetuses at 42 weeks, compared to 11.4 for vertex controls at the same gestational age. CONCLUSION: There is an increase in the risk of stillbirth in breech compared to vertex fetuses at all gestational ages. While more
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S85
Poster Session I research is needed to further explore the etiology of these differences, breech presentation may warrant a higher level of clinical concern, especially at term.
ajog.org saline to yield six different treatment groups (n¼7-9); control (placebo + saline), saline + 50mg/kg VC or 250mg/kg VC, nicotine + placebo, and nicotine + 50mg/kg or 250 mg/kg VC daily. Western blots were performed for the following histone PTMs: H3K4me3, H3K9me3, H3K27me3, H3K9ac, H3K14ac, H3PanAc and H4PanAc. Total histone H3 was used for normalization. RESULTS: As shown (Figure), analysis of specific histone PTMs demonstrate a significant difference between control and nicotine + 250mg/kg Vit C (NVC) groups in the placenta (H3K9me3, H3K9Ac, H3K27me3; p¼0.016, 0.027, 0.027 respectively) and in the lung (H3K4me3; p¼0.039). CONCLUSION: Nicotine and Vit C demonstrated a significant synergistic effect on the fetal placental and lung epigenome, with notable site-specific histone PTMs. Further study is warranted to investigate the effects of these epigenomic modifications on fetal lung and placental transcriptional networks following nicotine and Vit C exposure. These findings suggest that while Vit C may abrogate clinical impacts of nicotine exposure, the mechanisms are distinct.
125 Epigenetic changes associated with in utero nicotine exposure in the Rhesus macaque Stephen M. Saylor, Melissa Suter, Lyndsey Shorey-Kendrick, Min Hu, Antonio Frias, Elliot Spindel, Kjersti Aagaard 1
Baylor College of Medicine, Houston, TX, 2Oregon National Primate Research Center, Beaverton, OR, 3Oregon Health Sciences, Portland, OR, 4 Oregon National Primate Research Center, Beaverton, OK
OBJECTIVE: The prevalent use of e-cigarettes and other nicotine
products are increasing among women of reproductive age, making their effect on pregnancy an important public health concern. Nicotine is associated with adverse effects on the fetus including reduced placental blood perfusion and decreased fetal pulmonary function. Utilizing a rat model of in utero nicotine exposure, we have recently demonstrated epigenetic alterations in the lung and brain of offspring at postnatal day 1. Moreover, previous studies in nonhuman primates show effects of nicotine on fetal pulmonary function and oxidant radical production, and these effects are mitigated by treatment with the anti-oxidant Vitamin C (VC). Studies have also shown that nicotine is a potent histone deacetylase inhibitor. Based on these observations, we sought to determine the underlying molecular mechanisms. We hypothesized that differential histone post translational modifications (PTMs) would be detected in these tissues in response to nicotine, which may be further modulated upon Vit C treatment. STUDY DESIGN: In this preclinical study, PTMs were investigated in histones isolated from fetal lung and placenta from near term Rhesus macaques. Mothers received Vit C (VC) or placebo, and nicotine or
126 To inhale or not to inhale: a descriptive study of marijuana use and its effects in pregnancy from a contemporary large, population based cohort Kristin Chabarria, Diana A. Racusin, Maike Sachs, Melissa Suter, Joan Mastrobattista, Kjersti M. Aagaard 1
Baylor College of Medicine, Houston, TX
OBJECTIVE: Marijuana is believed to be the most widely used
controlled substance during pregnancy. However, there remains a general paucity of data regarding its use and subsequent perinatal morbidity. Recent cultural and political changes have lifted some of the stigma surrounding marijuana use, and thus likely result in greater honesty when gravidae are directly questioned regarding patterns of use. Our study seeks to examine maternal and neonatal outcomes in pregnancies affected by marijuana exposure. STUDY DESIGN: We applied a retrospective cohort study design to subjects (n¼12,069) with available information on marijuana use
S86 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org the regression model did not include GA and birth weight (aRR 1.8 [CI 1.2-2.8]) but did not persist in the model including GA and birth weight. 5 minute Apgar less than 7 also was more common in the previa group, but only when GA was not included in the regression model (aRR 2.1 [1.3-3.5]). CONCLUSION: More than 11% of neonates delivered to women with previa suffered meaningful morbidity and the mean gestational age at delivery was 35 weeks. Neonatal morbidity associated with previa is primarily associated with gestational age at delivery, rather than placental insufficiency or maternal hemorrhage.
RESULTS: Included in the study 119 CD for PP, that were characterized with lower gestational age, as compared to controls (n¼119),(35.8 4 vs. 38.8 2 weeks, p<0.001). Placentas in the PP group were smaller (P<0.001), with higher rate of placentas <10th% (p<0.001), as compared to controls. Higher rate of vascular lesions related to maternal underperfusion (p¼0.019), vascular and villous lesions consistent with FTOD (p¼0.024, p¼0.049), were detected in the PP group as compared to controls. Higher rate of FGR (p¼0.005), and worse composite neonatal outcome (45.3% vs. 11.8%, p<0.001) were also observed in the PP group as compared to controls. Using a multivariate logistic regression analysis, PP was found to be independently associated with placental maternal origin lesions (OR¼2.48, 95% CI 1.2-4.9, p¼0.009), placental FTOD lesions (OR-7.05, 95% CI 2.4-20.2, p<0.001), placental weight <10th% (OR-6.6, 95% CI 2.7-16.6, p<0.001). FGR was independently associated with PP (OR-10.09, 95% CI 2.3-44.2, p¼0.002). CONCLUSION: Worse neonatal outcome, higher rate of FGR, and higher rate of placental maternal and fetal origin vascular lesions, in pregnancies associated with PP, express underlying placental pathology, probably related to abnormal placentation and placental function.
124 The risk of stillbirth in breech fetuses stratified by gestational age Vanessa R. Lee, Jessica M. Page, Rachel A. Pilliod, Aaron B. Caughey 1 Oregon Health & Science University, Portland, OR, 2University of Utah, Salt Lake City, UT, 3Brigham and Women’s Hospital, Boston, MA
123 Increased placental vascular lesions and neonatal growth restriction characterize pregnancies complicated by placenta previa Eran Weiner, Hadas Miremberg, Ehud Grinstein, Yossi Mizrachi, Letizia Schreiber, Jacob Bar, Michal Kovo 1
Wolfson Medical Center, Holon, Israel
OBJECTIVE: To study the association between neonatal outcome and
placental histopathology lesions in pregnancies complicated by placenta previa (PP). STUDY DESIGN: Pregnancy and neonatal outcomes and placental pathology reports, from cesarean deliveries (CD) of PP (PP group) from 2009 to 2015, were reviewed. Results were compared to elective CD (control group) adjusted for maternal age and diseases. Placental lesions were categorized to vascular and villous lesions related to maternal underperfusion and fetal thromboocclusive disease (FTOD), and maternal and fetal inflammatory responses. Composite neonatal outcome was defined as one or more of early complications: ventilation, NEC, sepsis, transfusion, seizures, phototherapy, or death. FGR was defined as birth-weight < 10th percentile.
OBJECTIVE: We sought to characterize the weekly risk of intrauterine fetal death (IUFD) in breech fetuses compared to fetuses in vertex presentation. STUDY DESIGN: This is a retrospective cohort study of 1,907,052 singleton, nonanomalous pregnancies between 32-42 weeks’ gestation in California from 2005-2008. We calculated the risk of IUFD per 10,000 ongoing pregnancies for breech and vertex fetuses at each week of gestation. We used c2 tests to compare dichotomous variables and multivariate logistic regression to control for potential confounders in our entire cohort, and then calculated gestational age-specific risks using a pregnancies-at-risk life table method. RESULTS: There were 45,771 breech pregnancies and 1,861,281 vertex controls eligible for analysis. In our entire cohort, breech presentation was associated with higher odds of stillbirth with an adjusted odds ratio of 1.3 (95% CI 1.1-1.5) after controlling for maternal age, ethnicity, socioeconomic status, parity, diabetes, hypertensive disease, small-for-gestational age, and amniotic fluid volume disorders. When stratified by gestational age, the risk of stillbirth per 10,000 ongoing pregnancies was significantly higher in breech pregnancies compared to vertex pregnancies at each week of gestation. The risk of stillbirth was as high as 44.8 per 10,000 at-risk breech fetuses at 42 weeks, compared to 11.4 for vertex controls at the same gestational age. CONCLUSION: There is an increase in the risk of stillbirth in breech compared to vertex fetuses at all gestational ages. While more
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S85
Poster Session I research is needed to further explore the etiology of these differences, breech presentation may warrant a higher level of clinical concern, especially at term.
ajog.org saline to yield six different treatment groups (n¼7-9); control (placebo + saline), saline + 50mg/kg VC or 250mg/kg VC, nicotine + placebo, and nicotine + 50mg/kg or 250 mg/kg VC daily. Western blots were performed for the following histone PTMs: H3K4me3, H3K9me3, H3K27me3, H3K9ac, H3K14ac, H3PanAc and H4PanAc. Total histone H3 was used for normalization. RESULTS: As shown (Figure), analysis of specific histone PTMs demonstrate a significant difference between control and nicotine + 250mg/kg Vit C (NVC) groups in the placenta (H3K9me3, H3K9Ac, H3K27me3; p¼0.016, 0.027, 0.027 respectively) and in the lung (H3K4me3; p¼0.039). CONCLUSION: Nicotine and Vit C demonstrated a significant synergistic effect on the fetal placental and lung epigenome, with notable site-specific histone PTMs. Further study is warranted to investigate the effects of these epigenomic modifications on fetal lung and placental transcriptional networks following nicotine and Vit C exposure. These findings suggest that while Vit C may abrogate clinical impacts of nicotine exposure, the mechanisms are distinct.
125 Epigenetic changes associated with in utero nicotine exposure in the Rhesus macaque Stephen M. Saylor, Melissa Suter, Lyndsey Shorey-Kendrick, Min Hu, Antonio Frias, Elliot Spindel, Kjersti Aagaard 1
Baylor College of Medicine, Houston, TX, 2Oregon National Primate Research Center, Beaverton, OR, 3Oregon Health Sciences, Portland, OR, 4 Oregon National Primate Research Center, Beaverton, OK
OBJECTIVE: The prevalent use of e-cigarettes and other nicotine
products are increasing among women of reproductive age, making their effect on pregnancy an important public health concern. Nicotine is associated with adverse effects on the fetus including reduced placental blood perfusion and decreased fetal pulmonary function. Utilizing a rat model of in utero nicotine exposure, we have recently demonstrated epigenetic alterations in the lung and brain of offspring at postnatal day 1. Moreover, previous studies in nonhuman primates show effects of nicotine on fetal pulmonary function and oxidant radical production, and these effects are mitigated by treatment with the anti-oxidant Vitamin C (VC). Studies have also shown that nicotine is a potent histone deacetylase inhibitor. Based on these observations, we sought to determine the underlying molecular mechanisms. We hypothesized that differential histone post translational modifications (PTMs) would be detected in these tissues in response to nicotine, which may be further modulated upon Vit C treatment. STUDY DESIGN: In this preclinical study, PTMs were investigated in histones isolated from fetal lung and placenta from near term Rhesus macaques. Mothers received Vit C (VC) or placebo, and nicotine or
126 To inhale or not to inhale: a descriptive study of marijuana use and its effects in pregnancy from a contemporary large, population based cohort Kristin Chabarria, Diana A. Racusin, Maike Sachs, Melissa Suter, Joan Mastrobattista, Kjersti M. Aagaard 1
Baylor College of Medicine, Houston, TX
OBJECTIVE: Marijuana is believed to be the most widely used
controlled substance during pregnancy. However, there remains a general paucity of data regarding its use and subsequent perinatal morbidity. Recent cultural and political changes have lifted some of the stigma surrounding marijuana use, and thus likely result in greater honesty when gravidae are directly questioned regarding patterns of use. Our study seeks to examine maternal and neonatal outcomes in pregnancies affected by marijuana exposure. STUDY DESIGN: We applied a retrospective cohort study design to subjects (n¼12,069) with available information on marijuana use
S86 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016