- Email: [email protected]
or epilepsy
IDSOG Abstracts complications that may have been reduced if treated. Further studies are needed to improve detection and treatment of chorioamnionitis.
Figure 1 Maternal HBV DNA change from mid-trimester to delivery
ajog.org CONCLUSIONS: This study adds to the growing body of evidence
implicating immune-mediated exposures during fetal development in the etiology of autism, ID and epilepsy. The second trimester appears to represent a critical window of susceptibility during which maternal infection can disrupt core mechanisms involved in optimal fetal neurodevelopment.
Figure 1 Maternal inpatient infection diagnosis and relative risk of autism, ID or epilepsy
21 Prenatal infections and risk of autism, intellectual disability and/or epilepsy H. Haber1, G. Xing2, C. Walker3,4 1 School of Medicine, University of California, Davis, 2Center for Health Policy and Research, University of California, Davis, 3Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Davis, 4The MIND Institute, University of California, Davis
OBJECTIVES: Although studies have reported associations between
infections and febrile episodes during gestation and both autism and intellectual disability (ID) in offspring, results are mixed and limited to specific populations. We examined the association between maternal inpatient diagnosis of infection and childhood risk of autism, ID and epilepsy in a population-based birth cohort. METHODS: This retrospective cohort included California singleton births between 1/1/1991-12/31/2008 that survived the first year of life (n¼8,618,171). Infection during pregnancy was defined using ICD-9-CM codes from any maternal hospitalization and codes with fewer than 50 events were excluded. Birth files were merged with records from the California Department of Developmental Services (DDS) for children receiving care between 1/1/1991-12/31/2012, identifying 42,998 with autism, 45,546 with ID and 2,507 with epilepsy. Outcomes were defined by the DDS using standardized assessments and ICD-9-CM codes. Multinomial logistic regression models calculated relative risks (RRs) and 95% confidence intervals (CIs) for autism, ID or epilepsy in children according to maternal infection status, controlling for maternal age, race/ethnicity, educational attainment, payer, parity and birth year. Additional models using sub-categories of the predictor explored the effect of type, site, fever propensity and timing of infection on outcomes of interest. RESULTS: Maternal infection was associated with an increased risk for autism (8%), ID (33%) and epilepsy (43%) in adjusted analyses (Figure 1). Effects did not differ by infection febrile potential. Stronger associations were observed between infection sub-categories and ID and epilepsy, including bacterial etiology (increased by 43% and 57%, respectively) and respiratory (29% and 38%, respectively) and genitourinary (39% and 48%, respectively) sites. Outcome risk differed by timing of infection, with second trimester infections conferring a 24% increased risk for autism and a greater than two-fold risk for ID and epilepsy, and third trimester timing elevating risk to a lesser degree.
824 American Journal of Obstetrics & Gynecology DECEMBER 2016
22 Outcomes of a negative rapid influenza diagnostic test among pregnant women I. Datkhaeva, P. Has, K. Fitzgerald, B. Hughes Warren Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI
OBJECTIVES: To evaluate the negative predictive value (NPV) of a rapid influenza diagnostic test (RIDT) in comparison with that of a real-time reverse transcription (rRT)-PCR test in pregnant women. METHODS: A retrospective cohort was performed of all women who were pregnant or postpartum and had a negative RIDT followed by confirmatory rRT-PCR for influenza A, H1N1 and B during the influenza seasons from 2012-2015. Women were excluded if they only received one diagnostic test, were more than six weeks postpartum, were immunocompromised or were already receiving influenza treatment. The primary outcome was the NPV of the RIDT compared to the reference method of the rRT-PCR. Secondary outcomes included a demographic profile of influenza positive patients and factors associated with receiving antiviral treatment. RESULTS: Among 247 women studied, the NPV of the RIDT was 85.4%, 93.5% and 97.9% for influenza A, H1N1 and B, respectively. There was no change in the performance of the RIDT over the three seasons (p¼0.13). Women who were influenza A positive by rRTPCR were more likely to have a higher temperature (mean 37.5 vs. 37.3; p¼.03), cough (88.9.1% vs. 46.7%; p¼<.001), sore throat (50.0% vs. 29.5%; p¼<.001), coryza (52.8% vs. 27.9%; p¼.01) and fatigue (22.2% vs. 8.1%; p¼.048). Adjusted multivariable analysis revealed no difference in NPV among those with BMI greater than 30 (aOR 0.45, 95% [CI] 0.14-1.47). Antiviral treatment was administered to 47.2% (17 of 36) of women with a false negative RIDT for influenza A compared to 9.1% (19 of 210) of women with a true negative RIDT (p¼<.001). Patients were more likely to receive antiviral treatment if they were feverish (OR 4.49, 95% [CI] 1.6812.07), had cough (OR 5.17, 95% [CI] 1.17-22.76) or dyspnea (OR 3.87, 95% [CI] 1.29-11.64).
Figure 1 Maternal HBV DNA change from mid-trimester to delivery
ajog.org CONCLUSIONS: This study adds to the growing body of evidence
implicating immune-mediated exposures during fetal development in the etiology of autism, ID and epilepsy. The second trimester appears to represent a critical window of susceptibility during which maternal infection can disrupt core mechanisms involved in optimal fetal neurodevelopment.
Figure 1 Maternal inpatient infection diagnosis and relative risk of autism, ID or epilepsy
21 Prenatal infections and risk of autism, intellectual disability and/or epilepsy H. Haber1, G. Xing2, C. Walker3,4 1 School of Medicine, University of California, Davis, 2Center for Health Policy and Research, University of California, Davis, 3Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Davis, 4The MIND Institute, University of California, Davis
OBJECTIVES: Although studies have reported associations between
infections and febrile episodes during gestation and both autism and intellectual disability (ID) in offspring, results are mixed and limited to specific populations. We examined the association between maternal inpatient diagnosis of infection and childhood risk of autism, ID and epilepsy in a population-based birth cohort. METHODS: This retrospective cohort included California singleton births between 1/1/1991-12/31/2008 that survived the first year of life (n¼8,618,171). Infection during pregnancy was defined using ICD-9-CM codes from any maternal hospitalization and codes with fewer than 50 events were excluded. Birth files were merged with records from the California Department of Developmental Services (DDS) for children receiving care between 1/1/1991-12/31/2012, identifying 42,998 with autism, 45,546 with ID and 2,507 with epilepsy. Outcomes were defined by the DDS using standardized assessments and ICD-9-CM codes. Multinomial logistic regression models calculated relative risks (RRs) and 95% confidence intervals (CIs) for autism, ID or epilepsy in children according to maternal infection status, controlling for maternal age, race/ethnicity, educational attainment, payer, parity and birth year. Additional models using sub-categories of the predictor explored the effect of type, site, fever propensity and timing of infection on outcomes of interest. RESULTS: Maternal infection was associated with an increased risk for autism (8%), ID (33%) and epilepsy (43%) in adjusted analyses (Figure 1). Effects did not differ by infection febrile potential. Stronger associations were observed between infection sub-categories and ID and epilepsy, including bacterial etiology (increased by 43% and 57%, respectively) and respiratory (29% and 38%, respectively) and genitourinary (39% and 48%, respectively) sites. Outcome risk differed by timing of infection, with second trimester infections conferring a 24% increased risk for autism and a greater than two-fold risk for ID and epilepsy, and third trimester timing elevating risk to a lesser degree.
824 American Journal of Obstetrics & Gynecology DECEMBER 2016
22 Outcomes of a negative rapid influenza diagnostic test among pregnant women I. Datkhaeva, P. Has, K. Fitzgerald, B. Hughes Warren Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI
OBJECTIVES: To evaluate the negative predictive value (NPV) of a rapid influenza diagnostic test (RIDT) in comparison with that of a real-time reverse transcription (rRT)-PCR test in pregnant women. METHODS: A retrospective cohort was performed of all women who were pregnant or postpartum and had a negative RIDT followed by confirmatory rRT-PCR for influenza A, H1N1 and B during the influenza seasons from 2012-2015. Women were excluded if they only received one diagnostic test, were more than six weeks postpartum, were immunocompromised or were already receiving influenza treatment. The primary outcome was the NPV of the RIDT compared to the reference method of the rRT-PCR. Secondary outcomes included a demographic profile of influenza positive patients and factors associated with receiving antiviral treatment. RESULTS: Among 247 women studied, the NPV of the RIDT was 85.4%, 93.5% and 97.9% for influenza A, H1N1 and B, respectively. There was no change in the performance of the RIDT over the three seasons (p¼0.13). Women who were influenza A positive by rRTPCR were more likely to have a higher temperature (mean 37.5 vs. 37.3; p¼.03), cough (88.9.1% vs. 46.7%; p¼<.001), sore throat (50.0% vs. 29.5%; p¼<.001), coryza (52.8% vs. 27.9%; p¼.01) and fatigue (22.2% vs. 8.1%; p¼.048). Adjusted multivariable analysis revealed no difference in NPV among those with BMI greater than 30 (aOR 0.45, 95% [CI] 0.14-1.47). Antiviral treatment was administered to 47.2% (17 of 36) of women with a false negative RIDT for influenza A compared to 9.1% (19 of 210) of women with a true negative RIDT (p¼<.001). Patients were more likely to receive antiviral treatment if they were feverish (OR 4.49, 95% [CI] 1.6812.07), had cough (OR 5.17, 95% [CI] 1.17-22.76) or dyspnea (OR 3.87, 95% [CI] 1.29-11.64).