- Email: [email protected]
22: Outcomes of a negative rapid influenza diagnostic test among pregnant women
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).
ajog.org CONCLUSIONS: Up to 14.5% of women with a negative RIDT in
pregnancy had positive influenza by rRT-PCR of which over half did not receive antiviral treatment.
23 The impact of life-long maternal HIV infection on pregnancy outcomes in women delivering in south carolina A. M. Powell, S. Sullivan, D. E. Soper, G. B. Lazenby Medical University South Carolina, Charleston SC
OBJECTIVES: Our objective was to evaluate HIV RNA virologic suppression and pregnancy outcomes for women with perinatally acquired HIV infection (PHIV) compared to women with nonperinatal HIV (nPHIV) infection over a 10 year period. METHODS: Maternal and neonatal de-identified data was obtained from the South Carolina Department of Health and Environmental Control (DHEC) for all known HIV-infected women delivering in South Carolina from 2004-2014. Statistical analysis was performed using SAS 9.4 (Cary, NC). We compared maternal HIV RNA viral load,CD4 cell counts and pregnancy outcomes between women with PHIV versus nPHIV women. Continuous variables were compared with Student’s t-test and Wilcoxon Rank Sum Tests. Categorical variables were compared using c2 test and Fisher’s exact test. RESULTS: We identified 26 mothers with PHIV and 859 mother with nPHIV. PHIV mothers were more likely to have been diagnosed with HIV in a state other than South Carolina (19% vs 7%, p¼ 0.03) and use combination anti-retroviral therapy (cART) containing a protease inhibitor (85% vs 44%, p<0.0001) or alternative ART, including integrase inhibitors, CCR5 receptor antagonists, and fusion inhibitors (15% vs 2%, p¼0.004). PHIV were less likely to have antepartum cART that included AZT (38% vs 74%, p< 0.0001), deliver preterm (<37 weeks gestation) (4% vs 23%, p¼0.03), and deliver a low birthweight (< 2500 grams) infant (8% vs 27%, p¼0.02). PHIV women had no cases of neonatal death (0 vs 2%, p¼1.0), twin delivery (0 vs 4%, p¼0.6), nor perinatal HIV transmission to their infants (0 vs 1%, p¼1.0). PHIV and nPHIV women had similar rates of HIV RNA viral load > 1000 copies prior to delivery (13% vs 20%, p¼0.6) and undetectable HIV RNA viral load prior to delivery (44% vs 40%, p¼0.7). Rates of cesarean delivery were similar between groups (56% vs 54%, p¼0.8). The prevalence of HIV/AIDS (CD4 cell count < 200 cells/mm3) was similar in PHIV and nPHIV women (65% vs 49%, p¼0.09). CONCLUSIONS: Women with PHIV are more likely to be prescribed PI-based and alternative ART combinations during pregnancy, likely due to an increased rate of ART drug resistance with life-long HIV infection. However, these women did not have evidence of poorer HIV virologic suppression prior to delivery nor experience an increased rate of poor obstetric outcomes when compared with women with nPHIV.
24 Maternal immunoglobulin D induced by antepartum vaccination undergoes placental transfer to the fetus J. Guterman1, M. D. Pawlitz1,2,3, B. Pei1,2, J. Goyert1,2, K. S. Puder1, B. Gonik1, K. Chen1,2,3,4,5,6 1 Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA, 2Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, Michigan 48201, USA, 3Graduate
IDSOG Abstracts Program in Immunology and Microbiology, Department of Immunology and Microbiology, Wayne State University, Detroit, Michigan 48201, USA, 4 Department of Oncology, Wayne State University, Detroit, Michigan 48201, USA, 5Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Center, Detroit, Michigan 48201, USA, 6 Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
OBJECTIVES: The antibody immunoglobulin D (IgD) is evolutionarily conserved throughout the 500 million years of vertebrate evolution1, but its function has long been mysterious since its discovery over 50 years ago. We previously found that IgD is produced by plasmablasts in the upper respiratory mucosa and secreted IgD contributes to immune defense by reacting with respiratory bacteria and by activating the anti-microbial and immune-amplifying functions of basophils2. The goal of this study is to determine the induction and placental transfer of maternal vaccine-induced immunoglobulin D (IgD) and its function in the protection of neonates against respiratory infection. METHODS: The cytotrophoblast cell line BeWo cultured in transwells was used to determine the transcytosis of IgD. Pregnant Balb/c mice immunized with a Tetanus, diphtheria and acellular pertussis (Tdap) vaccine were used to determine maternal-to-fetal transfer of IgD across the placenta in pregnancy. ELISA was used to quantitate vaccine-specific IgD in culture media as well as in maternal and fetal circulation. RESULTS: IgD undergoes efficient apical-to-basolateral transcytosis across polarized BeWo cell monolayers in vitro, similarly as IgG. Maternal Tdap vaccination in pregnancy induces the production of vaccine-specific IgD and its transfer to the fetus, resulting in comparable levels of vaccine-specific IgD in fetal and maternal circulation at birth. CONCLUSIONS: Our results demonstrate that IgD is a new class of immunoglobulin that undergoes maternal-to-fetal transfer across the placenta. Maternal vaccine-specific IgD may provide an additional layer of immune protection to neonates besides IgG.
25 Mycoplasma genitalium and acute pelvic inflammatory disease H. C. Wiesenfeld, L. A. Meyn, I. S. Macio, C. Priest, G. Trucco, A. Amortegui, S. L. Hillier Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute, Pittsburgh, PA
OBJECTIVES: Mycoplasma genitalium is associated with some STD
syndromes, but whether it is a PID pathogen is unclear. We evaluated the role of MG in women with acute PID. METHODS: Women with acute PID were enrolled in a randomized controlled trial of two outpatient PID treatment regimens (ceftriaxone and doxycycline +/- metronidazole). Cervical and endometrial samples, obtained at enrollment and at 30 days following treatment, were tested for Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and M. genitalium (MG) by NAAT. Histologic assessment for endometritis was assessed independently by 2 blinded pathologists with quantification of neutrophils and plasma cells to determine acute endometritis (>5 PMNs per 400X surface epithelium and > 1 plasma cell per 100X) and plasma cell endometritis (> 1 plasma cell per 100X).
DECEMBER 2016 American Journal of Obstetrics & Gynecology
825
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).
ajog.org CONCLUSIONS: Up to 14.5% of women with a negative RIDT in
pregnancy had positive influenza by rRT-PCR of which over half did not receive antiviral treatment.
23 The impact of life-long maternal HIV infection on pregnancy outcomes in women delivering in south carolina A. M. Powell, S. Sullivan, D. E. Soper, G. B. Lazenby Medical University South Carolina, Charleston SC
OBJECTIVES: Our objective was to evaluate HIV RNA virologic suppression and pregnancy outcomes for women with perinatally acquired HIV infection (PHIV) compared to women with nonperinatal HIV (nPHIV) infection over a 10 year period. METHODS: Maternal and neonatal de-identified data was obtained from the South Carolina Department of Health and Environmental Control (DHEC) for all known HIV-infected women delivering in South Carolina from 2004-2014. Statistical analysis was performed using SAS 9.4 (Cary, NC). We compared maternal HIV RNA viral load,CD4 cell counts and pregnancy outcomes between women with PHIV versus nPHIV women. Continuous variables were compared with Student’s t-test and Wilcoxon Rank Sum Tests. Categorical variables were compared using c2 test and Fisher’s exact test. RESULTS: We identified 26 mothers with PHIV and 859 mother with nPHIV. PHIV mothers were more likely to have been diagnosed with HIV in a state other than South Carolina (19% vs 7%, p¼ 0.03) and use combination anti-retroviral therapy (cART) containing a protease inhibitor (85% vs 44%, p<0.0001) or alternative ART, including integrase inhibitors, CCR5 receptor antagonists, and fusion inhibitors (15% vs 2%, p¼0.004). PHIV were less likely to have antepartum cART that included AZT (38% vs 74%, p< 0.0001), deliver preterm (<37 weeks gestation) (4% vs 23%, p¼0.03), and deliver a low birthweight (< 2500 grams) infant (8% vs 27%, p¼0.02). PHIV women had no cases of neonatal death (0 vs 2%, p¼1.0), twin delivery (0 vs 4%, p¼0.6), nor perinatal HIV transmission to their infants (0 vs 1%, p¼1.0). PHIV and nPHIV women had similar rates of HIV RNA viral load > 1000 copies prior to delivery (13% vs 20%, p¼0.6) and undetectable HIV RNA viral load prior to delivery (44% vs 40%, p¼0.7). Rates of cesarean delivery were similar between groups (56% vs 54%, p¼0.8). The prevalence of HIV/AIDS (CD4 cell count < 200 cells/mm3) was similar in PHIV and nPHIV women (65% vs 49%, p¼0.09). CONCLUSIONS: Women with PHIV are more likely to be prescribed PI-based and alternative ART combinations during pregnancy, likely due to an increased rate of ART drug resistance with life-long HIV infection. However, these women did not have evidence of poorer HIV virologic suppression prior to delivery nor experience an increased rate of poor obstetric outcomes when compared with women with nPHIV.
24 Maternal immunoglobulin D induced by antepartum vaccination undergoes placental transfer to the fetus J. Guterman1, M. D. Pawlitz1,2,3, B. Pei1,2, J. Goyert1,2, K. S. Puder1, B. Gonik1, K. Chen1,2,3,4,5,6 1 Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA, 2Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, Michigan 48201, USA, 3Graduate
IDSOG Abstracts Program in Immunology and Microbiology, Department of Immunology and Microbiology, Wayne State University, Detroit, Michigan 48201, USA, 4 Department of Oncology, Wayne State University, Detroit, Michigan 48201, USA, 5Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Center, Detroit, Michigan 48201, USA, 6 Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
OBJECTIVES: The antibody immunoglobulin D (IgD) is evolutionarily conserved throughout the 500 million years of vertebrate evolution1, but its function has long been mysterious since its discovery over 50 years ago. We previously found that IgD is produced by plasmablasts in the upper respiratory mucosa and secreted IgD contributes to immune defense by reacting with respiratory bacteria and by activating the anti-microbial and immune-amplifying functions of basophils2. The goal of this study is to determine the induction and placental transfer of maternal vaccine-induced immunoglobulin D (IgD) and its function in the protection of neonates against respiratory infection. METHODS: The cytotrophoblast cell line BeWo cultured in transwells was used to determine the transcytosis of IgD. Pregnant Balb/c mice immunized with a Tetanus, diphtheria and acellular pertussis (Tdap) vaccine were used to determine maternal-to-fetal transfer of IgD across the placenta in pregnancy. ELISA was used to quantitate vaccine-specific IgD in culture media as well as in maternal and fetal circulation. RESULTS: IgD undergoes efficient apical-to-basolateral transcytosis across polarized BeWo cell monolayers in vitro, similarly as IgG. Maternal Tdap vaccination in pregnancy induces the production of vaccine-specific IgD and its transfer to the fetus, resulting in comparable levels of vaccine-specific IgD in fetal and maternal circulation at birth. CONCLUSIONS: Our results demonstrate that IgD is a new class of immunoglobulin that undergoes maternal-to-fetal transfer across the placenta. Maternal vaccine-specific IgD may provide an additional layer of immune protection to neonates besides IgG.
25 Mycoplasma genitalium and acute pelvic inflammatory disease H. C. Wiesenfeld, L. A. Meyn, I. S. Macio, C. Priest, G. Trucco, A. Amortegui, S. L. Hillier Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute, Pittsburgh, PA
OBJECTIVES: Mycoplasma genitalium is associated with some STD
syndromes, but whether it is a PID pathogen is unclear. We evaluated the role of MG in women with acute PID. METHODS: Women with acute PID were enrolled in a randomized controlled trial of two outpatient PID treatment regimens (ceftriaxone and doxycycline +/- metronidazole). Cervical and endometrial samples, obtained at enrollment and at 30 days following treatment, were tested for Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and M. genitalium (MG) by NAAT. Histologic assessment for endometritis was assessed independently by 2 blinded pathologists with quantification of neutrophils and plasma cells to determine acute endometritis (>5 PMNs per 400X surface epithelium and > 1 plasma cell per 100X) and plasma cell endometritis (> 1 plasma cell per 100X).
DECEMBER 2016 American Journal of Obstetrics & Gynecology
825