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169: Is a history of preeclampsia associated with an increased risk of small for gestational age in a future pregnancy?
Poster Session I
ajog.org
168 Levels of adipokines in amniotic fluid at the time of delivery in dichorionic-diamniotic twins discordant for fetal growth Seung Mi Lee, Joong Shin Park, Errol R. Norwitz, Sumin Oh, Sun Hye Yang, Sun Young Jung, Sun Min Kim, JoonHo Lee, Chan-Wook Park, Byoung Jae Kim, Jong Kwan Jun 1
Seoul National University College of Medicine, Seoul, Korea, Republic of, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea, Republic of, 3Tufts University School of Medicine, Boston, MA 2
OBJECTIVE: Adipokines are cytokines secreted by adipose tissue that
167 What is the yield of the work-up done in cases of Intrauterine Growth Restriction? Rivka Sukenik Halevy, Adi Katz, Rivka Regev, Tal Biron Shantal 1 genetic Institute and OB-GYN department, Meir Medical Center. Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel, 2Sackler School of Medicine, Tel Aviv University, Sackler School of Medicine, Tel Aviv University, Israel, 3Department of pediatrics, Meir Medical Center. Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
OBJECTIVE: Intra-Uterine Growth Restriction (IUGR) is associated
with different etiologies. The work-up preformed in these cases is targeted to determine the cause for IUGR and the existence of additional abnormalities. We opted to study the yield of tests performed as part of the routine work-up in IUGR pregnancies and the outcome of these pregnancies STUDY DESIGN: This retrospective study included a cohort of IUGR pregnancies (defined as estimated fetal eight below the 10th percentile) detected in Meir medical center during a two year period .Data regarding the work-up performed in these pregnancies including serology for infectious factors, genetic testing (karyotype, chromosomal microarray, FGFR3 mutations) and imaging (anatomical scan, fetal echocardiography) were retrieved from patient charts. We also evaluated data regarding medical problems which were diagnosed in the postnatal period. RESULTS: 198 IUGR pregnancies were included in our cohort; 72% were cases of isolated IUGR .The average gestational age at diagnosis was 33 5.6 weeks. In 80% at least some work-up done. Genetic counseling was performed in 42%; in 28% a karyotype was performed and in 2% CMA testing was done. No abnormalities were detected in genetic testing preformed prenatally. Echocardiogram preformed in 13.7% was abnormal in 4 cases (15.4%). Serological testing which was performed in 75.8% detected a CMV infection in one case (0.7%). Overall prenatal work-up was positive in 2.5% of pregnancies with IUGR. Ten newborns (5.1%) were diagnosed with a significant health problem after birth. There was one case of Down syndrome and one case Prader willi syndrome which were diagnosed postpartum. The rate of positive findings and the presence of significant problems after birth were not correlated with the severity of IUGR, the week of diagnosis, the symmetry or with obstetrical history. CONCLUSION: The cost-effectiveness of the tests performed as part of the work-up in IUGR pregnancies is not clear. The test with the highest yield is probably the fetal echocardiogram. The rate of significant problems after birth is increased in IUGR pregnancies.
modulate metabolic processes. Although the role of adipokines in fetal growth is not well understood, we have previously reported that concentrations of adiponectin and leptin are elevated in midtrimester amniotic fluid(AF) collected from the smaller compared with the larger fetus in dichorionic-diamniotic(DCDA) twin pairs discordant for growth [Am J Obstet Gynecol 2015;212:S870]. To determine the longitudinal changes of adipokine concentrations throughout pregnancy, we compared the concentrations of adipokines in AF at birth of discordant DCDA twin pairs. STUDY DESIGN: The study population consisted of discordant DCDA twins (birth weight difference >10%) whose AF were retrieved at the time of cesarean delivery. Samples were analyzed for selected chemokines (Complement Factor D/Adipsin, Serpin E1/PAI-1, Adiponectin/Acrp30, C-Reactive Protein [CRP], CCL2/MCP-1, Leptin, Resistin) using LuminexÒ Performance Assay multiplex kits. Data were analyzed using Wilcoxon signed rank test. RESULTS: A total of 39 twin pairs were enrolled. Concentrations of adiponectin and leptin in AF at birth were not significantly different between discordant twin pairs (see Table); however, the concentration of serpin E1 was significantly higher in AF collected from the smaller compared with the larger twin. This difference remained significant after adjustment for birth order and fetal sex. CONCLUSION: In discordant DCDA twins (a model system that controls for confounding environmental factors affecting fetal growth such as maternal obesity and gestational diabetes), the concentration of serpin E1 was significantly elevated in the AF of the smaller babies at birth. Serpin E1 may be an important adipokine for fetal programming of subsequent metabolic complications, because prior data suggest that elevated levels of serpin E1 may lead to metabolic syndrome in adults.
169 Is a history of preeclampsia associated with an increased risk of small for gestational age in a future pregnancy? Anna Palatnik, William A. Grobman, Emily S. Miller 1
Northwestern University, Feinberg School of Medicine, Chicago, IL
OBJECTIVE: A history of preeclampsia is associated with an increased
risk of preeclampsia in future pregnancy. However it is unclear whether women with prior preeclampsia are at increased risk of small for gestational age (SGA) in a subsequent pregnancy without
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S107
Poster Session I preeclampsia. The objective of this study was to evaluate whether women who have had preeclampsia are at increased risk of having a pregnancy complicated by SGA even in the absence of recurrent preeclampsia. STUDY DESIGN: This was a secondary analysis of data from two multicenter RCTs evaluating the role of aspirin in preeclampsia prevention in 1) nulliparous healthy women and 2) women at high risk of preeclampsia (e.g., chronic hypertension, pregestational diabetes or prior preeclampsia). The frequency of SGA without preeclampsia was compared after stratifying for reproductive history and co-morbidity (chronic hypertension or pregestational diabetes). Women with multiple gestations were excluded. Univariable analyses and multivariable logistic regression were performed. RESULTS: 4983 women were included in the analysis: 606 with prior preeclampsia, 3133 nulliparas without chronic hypertension or diabetes mellitus, and 1244 women with either chronic hypertension or pregestational diabetes. The frequency of SGA significantly differed by group (7.4% vs. 4.8% vs. 7.6%, respectively, p<0.001). In multivariable analysis, having had prior preeclampsia was associated with a significantly increased odds for SGA (Table). CONCLUSION: Even in the absence of recurrent preeclampsia, women with prior preeclampsia are at higher risk of SGA.
ajog.org and multivariable logistic regression were used to determine independent risk factors for SD. An ROC curve was created and AUC calculated to estimate the predictive capacity of these associations. RESULTS: Of 4080 women who underwent OVD (42.2% with a vacuum), SD occurred in 162 (3.9%). In bivariable analysis, mothers whose delivery was complicated by SD were younger (30.7 4.8 vs. 31.6 5.1, p¼.042), more likely to be multiparous (24.7% vs. 17.1%, p¼.013), had higher BMI (30.4 5.0 vs. 29.1 4.8, p<.001), and a higher frequency of chorioamnionitis (29.0% vs. 14.8%, p<.001) and diabetes mellitus (8.1% vs. 3.4%, p¼.002). Women with SD were less likely to undergo OVD due to fetal indications (34.6% vs. 48.2%, p¼.001) or be delivered by forceps (44.4% vs. 58.3%, p<.001). EFW was higher among women with SD (3.8kg 0.5 vs. 3.3kg 0.6, p<.001). In multivariable analysis, factors that remained independently associated with SD at the time of OVD were multiparity, maternal diabetes, chorioamnionitis, vacuum and EFW (Table). The AUC for this regression was 0.77 (95% CI 0.74 - 0.81) demonstrating imperfect prediction of SD (Figure). CONCLUSION: While risk factors for SD at the time of OVD can be identified, prediction of SD remains imperfect.
170 Predictors of shoulder dystocia at the time of operative vaginal delivery Anna Palatnik, William A. Grobman, Madeline G. Hellendag, Timothy M. Janetos, Dana R. Gossett, Emily S. Miller 1
Northwestern University, Feinberg School of Medicine, Chicago, IL, 2Kaiser Permanente Northern California, San Francisco, CA
OBJECTIVE: Shoulder dystocia (SD) has been shown to be more likely
in the setting of operative vaginal delivery (OVD), but it remains uncertain whether particular factors could be identified that would allow accurate prediction of which women would experience this adverse outcome. The objective of this study was to identify whether SD can be accurately predicted among women undergoing an OVD. STUDY DESIGN: This was a case-control study of women undergoing an OVD between October 2005 and May 2014 in a single tertiary care center. Cases were defined as women who experienced a SD at the time of delivery. Controls consisted of women without a SD at delivery. Variables previously identified to be associated with SD were abstracted from the medical records. An estimated fetal weight (EFW) was estimated by randomly varying the actual birth weight along a normal distribution with a mean of the actual birth weight as the mean and a standard deviation of 20% of the actual birth weight. Bivariable analyses
171 Maternal obesity and programmed offspring hyperphagia: differential effects of prenatal and postnatal exposure Mina Desai, Guang Han, Kavita Narwani, Marie H. Beall, Michael G. Ross 1 LABioMed at Harbor-UCLA Med. Ctr., Torrance, CA, 2LA Perinatal Assoc., Los Angeles, CA
OBJECTIVE: Maternal obesity/high fat diet increases the risk of offspring obesity in part due to altered development of appetite regulatory neurons in hypothalamic arcuate nucleus (ARC). The
S108 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org
168 Levels of adipokines in amniotic fluid at the time of delivery in dichorionic-diamniotic twins discordant for fetal growth Seung Mi Lee, Joong Shin Park, Errol R. Norwitz, Sumin Oh, Sun Hye Yang, Sun Young Jung, Sun Min Kim, JoonHo Lee, Chan-Wook Park, Byoung Jae Kim, Jong Kwan Jun 1
Seoul National University College of Medicine, Seoul, Korea, Republic of, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea, Republic of, 3Tufts University School of Medicine, Boston, MA 2
OBJECTIVE: Adipokines are cytokines secreted by adipose tissue that
167 What is the yield of the work-up done in cases of Intrauterine Growth Restriction? Rivka Sukenik Halevy, Adi Katz, Rivka Regev, Tal Biron Shantal 1 genetic Institute and OB-GYN department, Meir Medical Center. Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel, 2Sackler School of Medicine, Tel Aviv University, Sackler School of Medicine, Tel Aviv University, Israel, 3Department of pediatrics, Meir Medical Center. Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
OBJECTIVE: Intra-Uterine Growth Restriction (IUGR) is associated
with different etiologies. The work-up preformed in these cases is targeted to determine the cause for IUGR and the existence of additional abnormalities. We opted to study the yield of tests performed as part of the routine work-up in IUGR pregnancies and the outcome of these pregnancies STUDY DESIGN: This retrospective study included a cohort of IUGR pregnancies (defined as estimated fetal eight below the 10th percentile) detected in Meir medical center during a two year period .Data regarding the work-up performed in these pregnancies including serology for infectious factors, genetic testing (karyotype, chromosomal microarray, FGFR3 mutations) and imaging (anatomical scan, fetal echocardiography) were retrieved from patient charts. We also evaluated data regarding medical problems which were diagnosed in the postnatal period. RESULTS: 198 IUGR pregnancies were included in our cohort; 72% were cases of isolated IUGR .The average gestational age at diagnosis was 33 5.6 weeks. In 80% at least some work-up done. Genetic counseling was performed in 42%; in 28% a karyotype was performed and in 2% CMA testing was done. No abnormalities were detected in genetic testing preformed prenatally. Echocardiogram preformed in 13.7% was abnormal in 4 cases (15.4%). Serological testing which was performed in 75.8% detected a CMV infection in one case (0.7%). Overall prenatal work-up was positive in 2.5% of pregnancies with IUGR. Ten newborns (5.1%) were diagnosed with a significant health problem after birth. There was one case of Down syndrome and one case Prader willi syndrome which were diagnosed postpartum. The rate of positive findings and the presence of significant problems after birth were not correlated with the severity of IUGR, the week of diagnosis, the symmetry or with obstetrical history. CONCLUSION: The cost-effectiveness of the tests performed as part of the work-up in IUGR pregnancies is not clear. The test with the highest yield is probably the fetal echocardiogram. The rate of significant problems after birth is increased in IUGR pregnancies.
modulate metabolic processes. Although the role of adipokines in fetal growth is not well understood, we have previously reported that concentrations of adiponectin and leptin are elevated in midtrimester amniotic fluid(AF) collected from the smaller compared with the larger fetus in dichorionic-diamniotic(DCDA) twin pairs discordant for growth [Am J Obstet Gynecol 2015;212:S870]. To determine the longitudinal changes of adipokine concentrations throughout pregnancy, we compared the concentrations of adipokines in AF at birth of discordant DCDA twin pairs. STUDY DESIGN: The study population consisted of discordant DCDA twins (birth weight difference >10%) whose AF were retrieved at the time of cesarean delivery. Samples were analyzed for selected chemokines (Complement Factor D/Adipsin, Serpin E1/PAI-1, Adiponectin/Acrp30, C-Reactive Protein [CRP], CCL2/MCP-1, Leptin, Resistin) using LuminexÒ Performance Assay multiplex kits. Data were analyzed using Wilcoxon signed rank test. RESULTS: A total of 39 twin pairs were enrolled. Concentrations of adiponectin and leptin in AF at birth were not significantly different between discordant twin pairs (see Table); however, the concentration of serpin E1 was significantly higher in AF collected from the smaller compared with the larger twin. This difference remained significant after adjustment for birth order and fetal sex. CONCLUSION: In discordant DCDA twins (a model system that controls for confounding environmental factors affecting fetal growth such as maternal obesity and gestational diabetes), the concentration of serpin E1 was significantly elevated in the AF of the smaller babies at birth. Serpin E1 may be an important adipokine for fetal programming of subsequent metabolic complications, because prior data suggest that elevated levels of serpin E1 may lead to metabolic syndrome in adults.
169 Is a history of preeclampsia associated with an increased risk of small for gestational age in a future pregnancy? Anna Palatnik, William A. Grobman, Emily S. Miller 1
Northwestern University, Feinberg School of Medicine, Chicago, IL
OBJECTIVE: A history of preeclampsia is associated with an increased
risk of preeclampsia in future pregnancy. However it is unclear whether women with prior preeclampsia are at increased risk of small for gestational age (SGA) in a subsequent pregnancy without
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S107
Poster Session I preeclampsia. The objective of this study was to evaluate whether women who have had preeclampsia are at increased risk of having a pregnancy complicated by SGA even in the absence of recurrent preeclampsia. STUDY DESIGN: This was a secondary analysis of data from two multicenter RCTs evaluating the role of aspirin in preeclampsia prevention in 1) nulliparous healthy women and 2) women at high risk of preeclampsia (e.g., chronic hypertension, pregestational diabetes or prior preeclampsia). The frequency of SGA without preeclampsia was compared after stratifying for reproductive history and co-morbidity (chronic hypertension or pregestational diabetes). Women with multiple gestations were excluded. Univariable analyses and multivariable logistic regression were performed. RESULTS: 4983 women were included in the analysis: 606 with prior preeclampsia, 3133 nulliparas without chronic hypertension or diabetes mellitus, and 1244 women with either chronic hypertension or pregestational diabetes. The frequency of SGA significantly differed by group (7.4% vs. 4.8% vs. 7.6%, respectively, p<0.001). In multivariable analysis, having had prior preeclampsia was associated with a significantly increased odds for SGA (Table). CONCLUSION: Even in the absence of recurrent preeclampsia, women with prior preeclampsia are at higher risk of SGA.
ajog.org and multivariable logistic regression were used to determine independent risk factors for SD. An ROC curve was created and AUC calculated to estimate the predictive capacity of these associations. RESULTS: Of 4080 women who underwent OVD (42.2% with a vacuum), SD occurred in 162 (3.9%). In bivariable analysis, mothers whose delivery was complicated by SD were younger (30.7 4.8 vs. 31.6 5.1, p¼.042), more likely to be multiparous (24.7% vs. 17.1%, p¼.013), had higher BMI (30.4 5.0 vs. 29.1 4.8, p<.001), and a higher frequency of chorioamnionitis (29.0% vs. 14.8%, p<.001) and diabetes mellitus (8.1% vs. 3.4%, p¼.002). Women with SD were less likely to undergo OVD due to fetal indications (34.6% vs. 48.2%, p¼.001) or be delivered by forceps (44.4% vs. 58.3%, p<.001). EFW was higher among women with SD (3.8kg 0.5 vs. 3.3kg 0.6, p<.001). In multivariable analysis, factors that remained independently associated with SD at the time of OVD were multiparity, maternal diabetes, chorioamnionitis, vacuum and EFW (Table). The AUC for this regression was 0.77 (95% CI 0.74 - 0.81) demonstrating imperfect prediction of SD (Figure). CONCLUSION: While risk factors for SD at the time of OVD can be identified, prediction of SD remains imperfect.
170 Predictors of shoulder dystocia at the time of operative vaginal delivery Anna Palatnik, William A. Grobman, Madeline G. Hellendag, Timothy M. Janetos, Dana R. Gossett, Emily S. Miller 1
Northwestern University, Feinberg School of Medicine, Chicago, IL, 2Kaiser Permanente Northern California, San Francisco, CA
OBJECTIVE: Shoulder dystocia (SD) has been shown to be more likely
in the setting of operative vaginal delivery (OVD), but it remains uncertain whether particular factors could be identified that would allow accurate prediction of which women would experience this adverse outcome. The objective of this study was to identify whether SD can be accurately predicted among women undergoing an OVD. STUDY DESIGN: This was a case-control study of women undergoing an OVD between October 2005 and May 2014 in a single tertiary care center. Cases were defined as women who experienced a SD at the time of delivery. Controls consisted of women without a SD at delivery. Variables previously identified to be associated with SD were abstracted from the medical records. An estimated fetal weight (EFW) was estimated by randomly varying the actual birth weight along a normal distribution with a mean of the actual birth weight as the mean and a standard deviation of 20% of the actual birth weight. Bivariable analyses
171 Maternal obesity and programmed offspring hyperphagia: differential effects of prenatal and postnatal exposure Mina Desai, Guang Han, Kavita Narwani, Marie H. Beall, Michael G. Ross 1 LABioMed at Harbor-UCLA Med. Ctr., Torrance, CA, 2LA Perinatal Assoc., Los Angeles, CA
OBJECTIVE: Maternal obesity/high fat diet increases the risk of offspring obesity in part due to altered development of appetite regulatory neurons in hypothalamic arcuate nucleus (ARC). The
S108 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016