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173: Maternal body mass index: effect on pregnancy outcomes over a 10 year period
Poster Session I
% of Cesarean Sections
Clinical Obstetrics, Neonatology, Physiology-Endocrinology www.AJOG.org
Induction of labor (nⴝ148)
Spontaneous onset of labor (nⴝ483)
P
54.1%
11.4%
0.001
..........................................................................................................................................................................................
% of patients with 3.5% 2.4% 0.1 Apgar ⱕ 7 at 1 minute .......................................................................................................................................................................................... % of pateints with 0% 0.6% 0.5 Apgar ⱕ 7 at 5 minute .......................................................................................................................................................................................... Avarage # of neonatal 3.8⫾2.5 3⫾1.4 0.001 admission days ..........................................................................................................................................................................................
173 Maternal body mass index: effect on pregnancy outcomes over a 10 year period Tamula M. Patterson1, Alan T. Tita1, Suzanne P. Cliver1, Cherry L. Neely1, Joseph Biggio1 1
University of Alabama at Birmingham, Birmingham, AL
OBJECTIVE: Quantify the relationship of maternal body mass index
(BMI) and maternal and neonatal outcomes over a recent 10 year period. STUDY DESIGN: Retrospective cohort study of women delivering singletons ⬎20 weeks gestational age (GA) with recorded height and weight between 2000-2009 was conducted. Women were stratified by maternal BMI: underweight (⬍18.5), normal (18.5-24.9), overweight (25-29.9), obese (30-39.9) and morbidly obese (ⱖ40). Selected maternal and neonatal morbidities were analyzed and compared using Mantel Haenszel test for trend. Logistic regression was used to adjust for confounders when comparing underweight, overweight, obese and morbidly obese BMI categories to normal weight women. RESULTS: Of the 18,057 eligible women, 3% were underweight, 34% normal, 26% overweight, 27% obese and 9% morbidly obese. With increasing BMI, spontaneous preterm birth (PTB) and delivery of a SGA infant decreased significantly (trend p⬍ 0.0001 for both), while other pregnancy outcomes including gestational diabetes, hypertensive disorders, gestational hypertension, preeclampsia, chorioamnionitis, cesarean delivery, indicated PTB, birthweight ⬎4000 grams, and LGA significantly increased (all trend p⬍0.0001 except chorioamnionitis p⫽0.04). Adjusted risk ratios for selected outcomes according to maternal BMI when compared to normal BMI are presented (Table). CONCLUSIONS: Our data from the past 10 years quantify the dose response of maternal BMI on specific pregnancy outcomes. Underweight women are at increased risk for spontaneous preterm birth, while women with BMI ⱖ25 are at increased risk for gestational diabetes, hypertensive disorders, cesarean delivery and LGA infants. Thus, interventions are warranted to promote a normal BMI to decrease adverse consequences for pregnant women and their infants. Table. Pregnancy Outcomes by BMI categories compared to normal BMI women (Nⴝ6160).* Underweight (Nⴝ592)
Overweight (Nⴝ4685)
Obese (Nⴝ4917)
Morbidly Obese (Nⴝ1703)
Spontaneous PTB 1.39 [1.06-1.82] 0.88 [0.76-1.01] 0.65 [0.56-0.75] 0.45 [0.35-0.58]
..........................................................................................................................................................................................
Indicated PTB
0.80 [0.51-1.26] 1.13 [0.94-1.36] 1.44 [1.21-1.72] 1.76 [1.41-2.20]
C-Section
0.86 [0.67-1.12] 1.37 [1.23-1.52] 1.86 [1.68-2.05] 2.84 [2.49-3.24]
Gestational DM
1.20 [0.55-2.64] 1.97 [1.47-2.65] 3.95 [3.02-5.17] 5.30 [3.88-7.24]
Chorioamnionitis
0.63 [0.39-1.01] 1.34 [1.12-1.59] 1.58 [1.33-1.88] 1.60 [1.24-2.06]
.......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Hypertensive d/o
0.89 [0.64-1.23] 1.45 [1.27-1.67] 2.06 [1.81-2.35] 3.35 [2.85-3.93]
Gestational HTN
0.84 [0.50-1.41] 1.65 [1.34-2.03] 2.44 [2.02-2.97] 3.54 [2.80-4.46]
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
Preeclampsia
0.92 [0.60-1.41] 1.29 [1.08-1.55] 1.73 [1.46-2.06] 2.76 [2.24-3.41]
BWT ⬎ 4000 g
0.50 [0.25-1.03] 1.83 [1.50-2.22] 2.37 [1.96-2.87] 3.33 [2.63-4.22]
LGA – Brenner
0.49 [0.30-0.79] 1.74 [1.52-2.00] 2.22 [1.94-2.53] 3.07 [2.59-3.64]
SGA – Brenner
1.59 [1.21-2.09] 0.83 [0.71-0.97] 0.69 [0.59-0.82] 0.61 [0.48-0.79]
.......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
*Adjusted for race, parity, payer status, education, smoking, alcohol use and maternal age. PTB ⫽ preterm birth, DM ⫽ diabetes mellitus, HTN ⫽ hypertension, BWT ⫽ birthweight, LGA ⫽ large for gestational age, SGA ⫽ small for gestational age
S80
174 25 (OH) vitamin D levels do not change between the first and third trimesters with the standard prenatal vitamin dose of 400 IU of vitamin D Tiffany Blake-Lamb1, Chloe Zera1, Jennifer Stuart1, Scott Weiss1, Janet Rich-Edwards1, Louise Wilkins-Haug1, Thomas McElrath1 1
Brigham & Women’s Hospital, Boston, MA
OBJECTIVE: We tested the hypothesis that the standard 400 IU dose of
vitamin D found in prenatal vitamins (PNV) will prevent or correct first trimester 25-hydroxy-vitamin D (25-OH-D) deficiency. STUDY DESIGN: We conducted a nested case-control study of 426 women with singleton pregnancies followed prospectively from the initiation of prenatal care through delivery. We measured plasma 25OH-D concentrations in the first trimester (T1, mean 10.1 weeks) and third trimester (T3, mean 26.1 weeks). Maternal race and T1 PNV use were assessed by questionnaire. Regression was used to examine change in 25-OH-D concentration from T1 to T3 in women taking a PNV at T1, controlling for age, race, and season of conception. We had 80% power to detect a 30% change in mean 25-OH-D, assuming an alpha of 0.05. RESULTS: Among 306 women taking a T1 PNV, the mean (⫾SD) T1 25-OH-D level was 24.4 ⫾ 8.2 ng/mL compared to 18.7 ⫾ 8.6 ng/mL in 120 women not taking a T1 PNV (p⬍0.0001). Mean T3 25-OH-D levels (25.9 ⫾ 9.2 ng/mL) increased only slightly among women taking a PNV at T1 (p⫽0.03, adjusted for age, race, and season of conception). Of the women taking a T1 PNV, 29% were vitamin D deficient (⬍20 ng/ml) at T1 and 30% at T3. Fifty-eight (64%) of the 90 women taking a T1 PNV who were vitamin D deficient at baseline remained deficient in the third trimester. CONCLUSIONS: Although women taking a PNV at initial prenatal care have higher baseline 25-OH-D levels than women who are not taking a PNV, the continued use of a PNV from 1st to 3rd trimester is associated with only minimal increase in 25-OH-D level. The majority of vitamin D deficient women who took a PNV remained deficient in the third trimester. The standard dose of vitamin D in PNV’s is insufficient to protect women against vitamin D deficiency in pregnancy.
175 Rates of recurrent preterm delivery in women receiving 17 alpha-hydroxyprogesterone caproate by gestational age and reason for prior preterm birth Victor Hugo Gonzalez-Quintero1, Yvette C. Cordova1, Niki Istwan2, Felipe Tudela1, Debbie Rhea2, Adrian Marimon1, Cheryl Desch2, Leticia Maria Romary1, Gary Stanziano2 1
University of Miami, Miami, FL, 2Alere Health, Atlanta, GA
OBJECTIVE: Administration of 17P has been widely adopted in clinical
practice as a prophylactic treatment for prevention of recurrent preterm delivery. We sought to evaluate if rates of recurrent spontaneous preterm birth (SPTB) are different in women whose prior SPTB was due to preterm labor (PTL) or due to preterm premature rupture of membranes (PPROM). STUDY DESIGN: Identified from a database of women enrolled for outpatient 17P administration services were women with current singleton gestation having 1 prior SPTB resulting from PTL or PPROM. Included were those initiating 17P at 16-24.9 weeks’ gestation. Rates of recurrent SPTB (RSPTB) were compared between those with prior SPTB due to PTL or due to PPROM overall and within each gestational age (GA) at prior SPTB group (20-27.9 weeks, 28-33.9 weeks and 34-36.9 weeks) using Pearson’s chi-square (2-sided p-values ⬍0.05 considered statistically significant). RESULTS: Records from 2123 women were analyzed; 1639 (77.2%) with a prior SPTB due to PTL and 484 (22.8%) due to PPROM. In the overall population the rate of RSPTB ⬍37 weeks was 28.1%. The prior PTL group vs. the prior PPROM group experienced higher rates of recurrent SPTB at ⬍37 weeks of 29.7% vs. 22.9% (p⫽0.004), ⬍35 weeks of 14.0% vs. 9.1% (p⫽0.004), and ⬍32 weeks of 5.9% vs. 3.3% (p⫽0.024) respectively. Rates of RSPTB by GA at prior SPTB are presented in Table.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
% of Cesarean Sections
Clinical Obstetrics, Neonatology, Physiology-Endocrinology www.AJOG.org
Induction of labor (nⴝ148)
Spontaneous onset of labor (nⴝ483)
P
54.1%
11.4%
0.001
..........................................................................................................................................................................................
% of patients with 3.5% 2.4% 0.1 Apgar ⱕ 7 at 1 minute .......................................................................................................................................................................................... % of pateints with 0% 0.6% 0.5 Apgar ⱕ 7 at 5 minute .......................................................................................................................................................................................... Avarage # of neonatal 3.8⫾2.5 3⫾1.4 0.001 admission days ..........................................................................................................................................................................................
173 Maternal body mass index: effect on pregnancy outcomes over a 10 year period Tamula M. Patterson1, Alan T. Tita1, Suzanne P. Cliver1, Cherry L. Neely1, Joseph Biggio1 1
University of Alabama at Birmingham, Birmingham, AL
OBJECTIVE: Quantify the relationship of maternal body mass index
(BMI) and maternal and neonatal outcomes over a recent 10 year period. STUDY DESIGN: Retrospective cohort study of women delivering singletons ⬎20 weeks gestational age (GA) with recorded height and weight between 2000-2009 was conducted. Women were stratified by maternal BMI: underweight (⬍18.5), normal (18.5-24.9), overweight (25-29.9), obese (30-39.9) and morbidly obese (ⱖ40). Selected maternal and neonatal morbidities were analyzed and compared using Mantel Haenszel test for trend. Logistic regression was used to adjust for confounders when comparing underweight, overweight, obese and morbidly obese BMI categories to normal weight women. RESULTS: Of the 18,057 eligible women, 3% were underweight, 34% normal, 26% overweight, 27% obese and 9% morbidly obese. With increasing BMI, spontaneous preterm birth (PTB) and delivery of a SGA infant decreased significantly (trend p⬍ 0.0001 for both), while other pregnancy outcomes including gestational diabetes, hypertensive disorders, gestational hypertension, preeclampsia, chorioamnionitis, cesarean delivery, indicated PTB, birthweight ⬎4000 grams, and LGA significantly increased (all trend p⬍0.0001 except chorioamnionitis p⫽0.04). Adjusted risk ratios for selected outcomes according to maternal BMI when compared to normal BMI are presented (Table). CONCLUSIONS: Our data from the past 10 years quantify the dose response of maternal BMI on specific pregnancy outcomes. Underweight women are at increased risk for spontaneous preterm birth, while women with BMI ⱖ25 are at increased risk for gestational diabetes, hypertensive disorders, cesarean delivery and LGA infants. Thus, interventions are warranted to promote a normal BMI to decrease adverse consequences for pregnant women and their infants. Table. Pregnancy Outcomes by BMI categories compared to normal BMI women (Nⴝ6160).* Underweight (Nⴝ592)
Overweight (Nⴝ4685)
Obese (Nⴝ4917)
Morbidly Obese (Nⴝ1703)
Spontaneous PTB 1.39 [1.06-1.82] 0.88 [0.76-1.01] 0.65 [0.56-0.75] 0.45 [0.35-0.58]
..........................................................................................................................................................................................
Indicated PTB
0.80 [0.51-1.26] 1.13 [0.94-1.36] 1.44 [1.21-1.72] 1.76 [1.41-2.20]
C-Section
0.86 [0.67-1.12] 1.37 [1.23-1.52] 1.86 [1.68-2.05] 2.84 [2.49-3.24]
Gestational DM
1.20 [0.55-2.64] 1.97 [1.47-2.65] 3.95 [3.02-5.17] 5.30 [3.88-7.24]
Chorioamnionitis
0.63 [0.39-1.01] 1.34 [1.12-1.59] 1.58 [1.33-1.88] 1.60 [1.24-2.06]
.......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
Hypertensive d/o
0.89 [0.64-1.23] 1.45 [1.27-1.67] 2.06 [1.81-2.35] 3.35 [2.85-3.93]
Gestational HTN
0.84 [0.50-1.41] 1.65 [1.34-2.03] 2.44 [2.02-2.97] 3.54 [2.80-4.46]
.......................................................................................................................................................................................... ..........................................................................................................................................................................................
Preeclampsia
0.92 [0.60-1.41] 1.29 [1.08-1.55] 1.73 [1.46-2.06] 2.76 [2.24-3.41]
BWT ⬎ 4000 g
0.50 [0.25-1.03] 1.83 [1.50-2.22] 2.37 [1.96-2.87] 3.33 [2.63-4.22]
LGA – Brenner
0.49 [0.30-0.79] 1.74 [1.52-2.00] 2.22 [1.94-2.53] 3.07 [2.59-3.64]
SGA – Brenner
1.59 [1.21-2.09] 0.83 [0.71-0.97] 0.69 [0.59-0.82] 0.61 [0.48-0.79]
.......................................................................................................................................................................................... .......................................................................................................................................................................................... .......................................................................................................................................................................................... ..........................................................................................................................................................................................
*Adjusted for race, parity, payer status, education, smoking, alcohol use and maternal age. PTB ⫽ preterm birth, DM ⫽ diabetes mellitus, HTN ⫽ hypertension, BWT ⫽ birthweight, LGA ⫽ large for gestational age, SGA ⫽ small for gestational age
S80
174 25 (OH) vitamin D levels do not change between the first and third trimesters with the standard prenatal vitamin dose of 400 IU of vitamin D Tiffany Blake-Lamb1, Chloe Zera1, Jennifer Stuart1, Scott Weiss1, Janet Rich-Edwards1, Louise Wilkins-Haug1, Thomas McElrath1 1
Brigham & Women’s Hospital, Boston, MA
OBJECTIVE: We tested the hypothesis that the standard 400 IU dose of
vitamin D found in prenatal vitamins (PNV) will prevent or correct first trimester 25-hydroxy-vitamin D (25-OH-D) deficiency. STUDY DESIGN: We conducted a nested case-control study of 426 women with singleton pregnancies followed prospectively from the initiation of prenatal care through delivery. We measured plasma 25OH-D concentrations in the first trimester (T1, mean 10.1 weeks) and third trimester (T3, mean 26.1 weeks). Maternal race and T1 PNV use were assessed by questionnaire. Regression was used to examine change in 25-OH-D concentration from T1 to T3 in women taking a PNV at T1, controlling for age, race, and season of conception. We had 80% power to detect a 30% change in mean 25-OH-D, assuming an alpha of 0.05. RESULTS: Among 306 women taking a T1 PNV, the mean (⫾SD) T1 25-OH-D level was 24.4 ⫾ 8.2 ng/mL compared to 18.7 ⫾ 8.6 ng/mL in 120 women not taking a T1 PNV (p⬍0.0001). Mean T3 25-OH-D levels (25.9 ⫾ 9.2 ng/mL) increased only slightly among women taking a PNV at T1 (p⫽0.03, adjusted for age, race, and season of conception). Of the women taking a T1 PNV, 29% were vitamin D deficient (⬍20 ng/ml) at T1 and 30% at T3. Fifty-eight (64%) of the 90 women taking a T1 PNV who were vitamin D deficient at baseline remained deficient in the third trimester. CONCLUSIONS: Although women taking a PNV at initial prenatal care have higher baseline 25-OH-D levels than women who are not taking a PNV, the continued use of a PNV from 1st to 3rd trimester is associated with only minimal increase in 25-OH-D level. The majority of vitamin D deficient women who took a PNV remained deficient in the third trimester. The standard dose of vitamin D in PNV’s is insufficient to protect women against vitamin D deficiency in pregnancy.
175 Rates of recurrent preterm delivery in women receiving 17 alpha-hydroxyprogesterone caproate by gestational age and reason for prior preterm birth Victor Hugo Gonzalez-Quintero1, Yvette C. Cordova1, Niki Istwan2, Felipe Tudela1, Debbie Rhea2, Adrian Marimon1, Cheryl Desch2, Leticia Maria Romary1, Gary Stanziano2 1
University of Miami, Miami, FL, 2Alere Health, Atlanta, GA
OBJECTIVE: Administration of 17P has been widely adopted in clinical
practice as a prophylactic treatment for prevention of recurrent preterm delivery. We sought to evaluate if rates of recurrent spontaneous preterm birth (SPTB) are different in women whose prior SPTB was due to preterm labor (PTL) or due to preterm premature rupture of membranes (PPROM). STUDY DESIGN: Identified from a database of women enrolled for outpatient 17P administration services were women with current singleton gestation having 1 prior SPTB resulting from PTL or PPROM. Included were those initiating 17P at 16-24.9 weeks’ gestation. Rates of recurrent SPTB (RSPTB) were compared between those with prior SPTB due to PTL or due to PPROM overall and within each gestational age (GA) at prior SPTB group (20-27.9 weeks, 28-33.9 weeks and 34-36.9 weeks) using Pearson’s chi-square (2-sided p-values ⬍0.05 considered statistically significant). RESULTS: Records from 2123 women were analyzed; 1639 (77.2%) with a prior SPTB due to PTL and 484 (22.8%) due to PPROM. In the overall population the rate of RSPTB ⬍37 weeks was 28.1%. The prior PTL group vs. the prior PPROM group experienced higher rates of recurrent SPTB at ⬍37 weeks of 29.7% vs. 22.9% (p⫽0.004), ⬍35 weeks of 14.0% vs. 9.1% (p⫽0.004), and ⬍32 weeks of 5.9% vs. 3.3% (p⫽0.024) respectively. Rates of RSPTB by GA at prior SPTB are presented in Table.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011