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211: An increased future risk for ophthalmic complications in patients with a history of preeclampsia
Poster Session I
ajog.org
211 An increased future risk for ophthalmic complications in patients with a history of preeclampsia
Ofer Beharier1, Roy Kessous1, Ruslan Sergienko2, Ehud Davidson3, Eyal Sheiner1
1 Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Faculty of Health Sciences, BeerSheva, Israel, 2Ben-Gurion University of the Negev, Department of Public Health, Beer-Sheva, Israel, Beer sheva, Israel, 3Soroka University Medical Center management, Clalit Health Services (Southern District), Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Beer sheva, Israel
OBJECTIVE: To investigate whether patients with a history of preeclampsia have an increased risk for subsequent long-term ophthalmic complications. STUDY DESIGN: A population-based study compared the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a prior history of preeclampsia. Deliveries occurred between the years 1988-2013, mean follow-up of 12 years. Excluded from the study were women with chronic hypertension and known ophthalmic diseases. Ophthalmic complications were divided to specific type including glaucoma, diabetic retinopathy, macular degeneration and retinal detachment. Kaplan-Meier survival curve was used to estimate cumulative incidence of ophthalmic complications. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for ophthalmic complications. RESULTS: During the study period 103,183 deliveries met the inclusion criteria; 8.1% (n¼8324) occurred in patients with a diagnosis of preeclampsia during at least one of their pregnancies. Patients with preeclampsia had a significantly higher incidence of long-term ophthalmic complications such as diabetic retinopathy and retinal detachment (table). In addition, a significant linear association was found between the severity of preeclampsia (mild vs. severe vs. eclampsia) and the risk for ophthalmic complications (0.3% vs. 0.5% vs. 2.2%; respectively). Using a Kaplan-Meier survival curve, patients with a history of preeclampsia had a significantly higher cumulative incidence of ophthalmic complications (Figure). Using a Cox proportional hazards model, adjusted for confounders such as maternal age, diabetes and obesity, a history of preeclampsia remained independently associated with ophthalmic complications (adjusted HR, 1.9; 95% CI, 1.3-2.7; P¼0.001). CONCLUSION: Preeclampsia is an independent risk factor for long term ophthalmic complications, and specifically diabetic retinopathy and retinal detachment. This risk is more substantial depending on the severity of the disease.
Ophthalmic complications in patients with and without preeclampsia
212 Should the current DHHS recommendations for use of antiretroviral drugs in maternal HIV-1 RNA undergo a review? An urban academic experience Olaide Ashimi1, Emily Hoff1, Baha Sibai1, Robin Hardwicke1 1
UT Health- University of Texas Medical School at Houston, OB/GYN, Houston, TX
OBJECTIVE: The Department of Health and Human Services(DHHS) recommends certain medicationsfor HIV-1 infected women during pregnancy(Table1).Studies show vertical transmission of<1% while taking HAART as suggested in the guidelines.Unfortunately, preferred regimens(PR) are not necessarily clinically favored due to intolerance.Existing alternative regimens(AR); one pill daily, are available, however, there is insufficient data in pregnancy(Table1).This study’s objective is to compare maternal and infant outcome among those prescribed PR vs.AR. STUDY DESIGN: A retrospective review was performed on 96 HIV-1 infected women delivering between 2007-2014 at two university hospitals.The study only included HIV-1 infected women currently taking PR or AR at initial visit.Demographics and outcomes were collected. Mann-Whitney U,Person’s Chi-squared or Fischer’s exact test determined statistical significance (p<0.05) performed using SPSS. RESULTS: Of 96 patients, 83.3% were prescribed PR by the DHHS guidelines, while 16.7% prescribed AR.HIV drug resistance upon initial visit to care was more prevalent among women on PR (55%) than on AR (25%).Women on PR were more likely to present to the county hospital than women on AR.Compared to women on AR, the rate of viral load greater than 1000 copies/mL directly prior to delivery was significantly higher in those receiving PR. There was one case of vertical transmission in which the patient was changed from a
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
S119
ajog.org
211 An increased future risk for ophthalmic complications in patients with a history of preeclampsia
Ofer Beharier1, Roy Kessous1, Ruslan Sergienko2, Ehud Davidson3, Eyal Sheiner1
1 Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Faculty of Health Sciences, BeerSheva, Israel, 2Ben-Gurion University of the Negev, Department of Public Health, Beer-Sheva, Israel, Beer sheva, Israel, 3Soroka University Medical Center management, Clalit Health Services (Southern District), Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Beer sheva, Israel
OBJECTIVE: To investigate whether patients with a history of preeclampsia have an increased risk for subsequent long-term ophthalmic complications. STUDY DESIGN: A population-based study compared the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a prior history of preeclampsia. Deliveries occurred between the years 1988-2013, mean follow-up of 12 years. Excluded from the study were women with chronic hypertension and known ophthalmic diseases. Ophthalmic complications were divided to specific type including glaucoma, diabetic retinopathy, macular degeneration and retinal detachment. Kaplan-Meier survival curve was used to estimate cumulative incidence of ophthalmic complications. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for ophthalmic complications. RESULTS: During the study period 103,183 deliveries met the inclusion criteria; 8.1% (n¼8324) occurred in patients with a diagnosis of preeclampsia during at least one of their pregnancies. Patients with preeclampsia had a significantly higher incidence of long-term ophthalmic complications such as diabetic retinopathy and retinal detachment (table). In addition, a significant linear association was found between the severity of preeclampsia (mild vs. severe vs. eclampsia) and the risk for ophthalmic complications (0.3% vs. 0.5% vs. 2.2%; respectively). Using a Kaplan-Meier survival curve, patients with a history of preeclampsia had a significantly higher cumulative incidence of ophthalmic complications (Figure). Using a Cox proportional hazards model, adjusted for confounders such as maternal age, diabetes and obesity, a history of preeclampsia remained independently associated with ophthalmic complications (adjusted HR, 1.9; 95% CI, 1.3-2.7; P¼0.001). CONCLUSION: Preeclampsia is an independent risk factor for long term ophthalmic complications, and specifically diabetic retinopathy and retinal detachment. This risk is more substantial depending on the severity of the disease.
Ophthalmic complications in patients with and without preeclampsia
212 Should the current DHHS recommendations for use of antiretroviral drugs in maternal HIV-1 RNA undergo a review? An urban academic experience Olaide Ashimi1, Emily Hoff1, Baha Sibai1, Robin Hardwicke1 1
UT Health- University of Texas Medical School at Houston, OB/GYN, Houston, TX
OBJECTIVE: The Department of Health and Human Services(DHHS) recommends certain medicationsfor HIV-1 infected women during pregnancy(Table1).Studies show vertical transmission of<1% while taking HAART as suggested in the guidelines.Unfortunately, preferred regimens(PR) are not necessarily clinically favored due to intolerance.Existing alternative regimens(AR); one pill daily, are available, however, there is insufficient data in pregnancy(Table1).This study’s objective is to compare maternal and infant outcome among those prescribed PR vs.AR. STUDY DESIGN: A retrospective review was performed on 96 HIV-1 infected women delivering between 2007-2014 at two university hospitals.The study only included HIV-1 infected women currently taking PR or AR at initial visit.Demographics and outcomes were collected. Mann-Whitney U,Person’s Chi-squared or Fischer’s exact test determined statistical significance (p<0.05) performed using SPSS. RESULTS: Of 96 patients, 83.3% were prescribed PR by the DHHS guidelines, while 16.7% prescribed AR.HIV drug resistance upon initial visit to care was more prevalent among women on PR (55%) than on AR (25%).Women on PR were more likely to present to the county hospital than women on AR.Compared to women on AR, the rate of viral load greater than 1000 copies/mL directly prior to delivery was significantly higher in those receiving PR. There was one case of vertical transmission in which the patient was changed from a
Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology
S119