- Email: [email protected]
271: Is indomethacin associated with perinatal morbidity in the neonate?
Poster Session II
ajog.org
BMI 40, BMI 45, as well as weight gain above or below Institute of Medicine (IOM) guidelines were investigated. RESULTS: Of 44 patients during the study period, 28 (63.6%) were maintained at therapeutic anti-Xa levels using weight based dosing, while 16 (36.4%) required dose adjustments. BMI 45.0 was significantly associated with need for dose change based on anti-Xa levels (RR 3.33, 95% CI 2.08, 5.35). All patients with BMI 45.0 needed dosing adjustment to less than their weight based dosage. Other than BMI 45.0, there were no significant risk factors for needing non-weight based dosing (Table). CONCLUSION: Although many patients reach therapeutic anti-Xa levels using weight based dosing of LMWH, more than one-third require non weight based therapy. This suggests that monitoring of antiXa levels after initial weight based dosing for pregnant women requiring therapeutic anticoagulation with LMWH is necessary, particularly among the morbidly obese.
CONCLUSION: Magnesium sulfate exposure near the time of delivery and retreatment with magnesium is associated with reduced odds of cerebral palsy, suggesting timing of prophylaxis is important for neuroprotection. Further studies are needed to determine the optimal magnesium regimen for prevention of cerebral palsy.
Risk factors associated with the need for non-weight based dosing of LMWH based on anti-Xa levels. Risk Factor (n=44)
Patients requiring dosage adjustments and non- Patients receiving weight weight based therapy based therapy (n=16) (n=28)
Relative Risk (95% CI)
BMI ≥ 30.0
9 (56.3%)
19 (67.9%)
0.73 (0.34,1.59)
BMI ≥ 40.0
6 (37.5%)
8 (28.6%)
1.29 (0.58,2.83)
BMI ≥ 45.0
4 (25.0%)
0 (0%)
3.33 (2.08, 5.35)
Weight Gain less than IOM recommendations by BMI
6 (37.5%)
13 (46.4%)
0.79 (0.35,1.79)
Weight Gain over IOM recommendations by BMI
5 (31.5%)
7 (25.0%)
1.21 (0.53,2.76)
270 Characteristics of magnesium sulfate administration and cerebral palsy Gloria Too1, Amy L. Turitz1, Cynthia Gyamfi-Bannerman1 1
Columbia University, New York, NY
OBJECTIVE: In women at risk for preterm delivery, magnesium sulfate
(Mg) reduces the risk of cerebral palsy (CP) in surviving children. The optimal dosing and timing for the prevention of CP have not been clearly defined. Our objective is to evaluate the characteristics of Mg exposure in pregnancies at risk for CP. STUDY DESIGN: This case-control study is a secondary analysis of a multicenter trial evaluating the use of Mg the prevention of CP. We included women with non-anomalous singleton gestations who were exposed to magnesium for neuroprotection during pregnancy and excluded antepartum stillbirths and patients with incomplete outcome ascertainment. Characteristics of magnesium use, including umbilical cord blood Mg level, total grams of Mg, total hours of Mg infusion, Mg exposure within 12 hours of delivery, retreatment after completion of initial Mg course, and infusion at the time of delivery were compared in cases who developed CP and controls who did not. Individual Mg characteristics were adjusted for gestational age at delivery, mode of delivery, and total grams of Mg fitting a logistic regression model. RESULTS: Of the 906 women who received Mg, CP occurred in 28 children (3.09%). Birth weight, gestational age at delivery, and delivery route were different between the groups. The CP group received fewer hours and fewer grams of magnesium. The umbilical cord blood Mg level was similar in the two groups (2.79 vs 2.59, p ¼ 0.51). Retreatment with Mg when delivery was imminent was associated with a significantly decreased risk of CP (Table). There was a trend towards reduced odds of cerebral palsy with magnesium infusion at the time of delivery (OR 0.50, 95% CI 0.23 - 1.08); but this finding was not significantly significant, p ¼ 0.08. On adjusted analyses, Mg exposure within 12 hours of birth associated was also associated with a signification reduction in CP.
271 Is indomethacin associated with perinatal morbidity in the neonate? YeonJung Park1, Eugene Chang1, Tripp Nelson1, Myla D. Ebeling1, Sanjay Patwardhan1 1
Medical University of South Carolina, Charleston, SC
OBJECTIVE: Preterm birth remains a major source of perinatal
morbidity and mortality. Recent studies have demonstrated an increase in the risk of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC) in neonates exposed to indomethacin. The objective of this study is to determine whether indomethacin given for tocolysis at a single institution is associated with an increase in the risk of IVH, PVL, and NEC. STUDY DESIGN: This was a retrospective cohort study of pregnant patients with nonanomalous fetuses delivering between 22-34 weeks who received indomethacin compared to those who did not. The primary outcome studied was composite neonatal morbidity, including grade III/IV IVH, neonatal seizures, PVL, and NEC using data from a research quality database (Perinatal Information Network System (PINS) database) at MUSC. Outcomes were stratified based on gestational age at delivery: 22-24 weeks, 24-26 weeks, 26-28 weeks, 28-32 weeks, and 32-34 weeks gestation. Maternal demographic and additional clinical information were collected. Statistical analysis included chi-square and Student’s t-test where appropriate with 95% confidence intervals and clinical significance determined with a p<0.05. Linear regression modeling was used to determine the significance of exposure of indomethacin with subsequent neonatal morbidity as detailed above. RESULTS: There were 3257 live births between 2009-2013 that were delivered between 22 and 34 weeks and admitted to the newborn nursery. Of these live births, 437 newborns were exposed to antenatal indomethacin and 2820 newborns were not exposed. There was a significant increase in the risk of IVH/PVL with indomethacin. Additionally, there was a greater incidence of NEC, IVH, PVL in the extreme prematurity group (ie between 22-24 weeks, 24-26 weeks). Using logistic regression and controlling for indocin, magnesium sulfate, betamethasone, and gestational age, only lower gestational age was associated with severe IVH, NEC, and PVL.
S158 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
Poster Session II
ajog.org CONCLUSION: Indomethacin does not appear to be an independent
risk factor for IVH, PVL, and NEC when accounting for gestational age at delivery.
272 Shock Index: A potential criterion for a maternal early warning system Catherine S. Eppes1, Jaden Schupp1, Gary Dildy1 1
Baylor College of Medicine, Houston, TX
OBJECTIVE: Postpartum hemorrhage (PPH) is one of the most
common causes of maternal mortality and severe morbidity in the United States and worldwide. The National Partnership for Maternal Safety has proposed development of a Maternal Early Warning Obstetrical Score (MEOWS) based on vital signs to facilitate timely recognition, diagnosis and treatment of women with critical illness. Shock index (SI), calculated as heart rate divided by systolic blood pressure, has been proposed as a metric to predict early hypovolemia and need for transfusion or operative management in trauma settings. We sought to explore how SI relates to PPH and need for transfusion STUDY DESIGN: The SI and delta-SI (peak SI - baseline SI) were calculated for all peripartum vital sign determinations in 50 controls (those without PPH) and 25 cases (those with PPH). Receiver operating characteristic (ROC) curves were plotted for discrimination threshold. Data in table 1 are reported as mean (+/- SD). RESULTS: Descriptive statistics are displayed in table 1. The baseline pre-labor SI was the same for each group. The peak SI differed significantly between controls and cases (p¼0.03). The delta-SI was significantly higher in cases than in controls (p¼0.01). SI was not a sensitive predictor of transfusion, however the delta-SI was highly predictive; a threshold of 0.34 had 91% sensitivity and 90% specificity. Delta-SI was more predictive of need for transfusion then estimated blood loss (ROC area 0.9512 versus 0.9075, p¼0.4), however not significantly. For the 6 patients who required hysterectomy following PPH a delta-SI threshold of 0.373 predicted need for surgical intervention with 100% Sensitivity and 89% specificity. Although limited by small numbers, this difference held true even with the diagnosis of preeclampsia. CONCLUSION: The SI or a variant such as delta-SI may be a valuable predictor of maternal deterioration, the need for transfusion, or operative intervention in the setting of PPH. Shock index and Delta-SI Shock index ControlN=50 All PPH N=25 PPH requiring transfusionsn=8 PPH requiring hysterectomyN=6 Baseline
0.74 +/- 0.13 0.74 +/- 0.13 0.71 +/- 0.21
Labor
0.79 +/- 0.20
0.77 +/- 0.27
Peak
0.88 +/- 0.15 1.28 +/- 0.34 1.20 +/- 0.32
1.3 +/- 0.33
Delta-SI
0.19 +/- 0.23 0.39 +/- 0.24 0.50 +/- 0.20
0.53 +/- 0.20
Maternal and neonatal outcomes. Low-GI Group (69) Group C (62) p-value Gestational diabetes mellitus (GDM)
23 (37.1%)
0.019
Large for gestational age (LGA ≥ 90° centile) 1 (1.4%)
13 (18.8%)
7 (11.3%)
0.019
Pregnancy induced hypertension (PIH)
2 (2.9%)
13 (21%)
0.001
Preterm birth (PTB)
0
5 (8.1%)
0.016
Small for gestational age (SGA ≤ 10° centile) 6 (8.7%)
5 (8.1%)
0.897
Induction of labor
24 (34.8%)
34 (54.8%)
0.021
GWG at 36th week (kg)
9.5±6.4
9.1±6.7
0.749
274 Stillbirth and neonatal adverse outcomes in pregnancies complicated by preexisting and gestational diabetes Alexander M. Friedman1, Cande V. Ananth1, Zainab Siddiq1, Mary E. D’Alton1, Jason D. Wright1 1
Columbia University, New York, NY
OBJECTIVE: The objective of this study was to evaluate the risk for
273 A customized low glycaemic-index (GI) diet prevents both the gestational diabetes mellitus (GDM) and the large for gestational age (LGA) babies in overweight/obese pregnant women Elisabetta Petrella1, Raffaele Bruno1, Giulia Pedrielli1, Valentina Bertarini1, Isabella Neri1, Fabio Facchinetti1 1
trial. Forty-seven refused to participate and 191 were assigned to Intervention (low-GI¼96; low GI-diet of 1800 Kcal/day, prescribed by a dietitian, + 30 minutes walking 3 times/week, measured with pedometer) or Controls (C¼95; lifestyle advices, according to national guidelines). Follow-up (including the gestational weight gainGWG) was planned at 18th, 24nd, 30th and 35th week. At enrollment and at 35th week, Food frequency Questionnaire (FFQ) was filled-in. RESULTS: The socio-demographic characteristics at randomisation were similar. Miscarriages occurred in 6.8%, dropout in 24.6%, leaving at analysis 131 women. Both GDM and LGA were less represented in the low-GI group (Table). According to FFQ, low-GI group showed more adherence (n¼40, 57.9%) respect with C group (n¼24, 38.7%; p:0.028). At logistic regression analysis, the GDM occurrence was explained by both group allocation (OR¼3.9, CI 95%: 1.1-14.4) and lower BMI category (OR¼2.6, CI 95%: 1.1-6.4), after correcting for the confounders (family history of diabetes, age 35 y, Caucasian ethnicity). Significant changes in the consumption of each investigated food were observed only in low-GI group. GWG was similar in both arms. SGA newborns were equally distributed. Low-GI group showed fewer interventions at parturition. CONCLUSION: The current practice of providing general lifestyle advices (through leaflets or directly by providers) is not sufficient to reduce GDM and related complications in overweight/obese women, whereas a customized low-GI diet started early in pregnancy increases the adherence and reduces GDM as well as LGA babies occurrence.
University of Modena and Reggio Emilia, Modena, Italy
OBJECTIVE: To determine whether the prescription/follow-up of a
behavioural program influences the adherence to a healthier lifestyle, thus affecting the GDM occurrence and unfavourable maternal/ neonatal outcomes. STUDY DESIGN: Between the 9-12th week, 238 women with BMI25 were enrolled in a prospective, open-label, randomized controlled
stillbirth and adverse neonatal outcomes in pregnancies complicated by gestational or preexisting diabetes at or nearing term. STUDY DESIGN: This population-based study of U.S. natality records from 2005-2013 evaluated neonatal outcomes and cumulative risk for stillbirth for pregnancies complicated by preexisting and gestational diabetes delivering at 36 weeks gestational age. Only singleton, non-anomalous pregnancies without chronic hypertension and/or preeclampsia/gestational hypertension were included. For delivery at each week of gestation, risk was determined for a composite adverse neonatal outcome that included the following conditions: assisted ventilation for >6 hours, NICU admission, antibiotic administration for suspected neonatal sepsis, surfactant use, neonatal seizures or serious neurologic dysfunction, and/or Apgar score <7 at 5 minutes. Multivariable log-linear regression models were developed to create an adjusted model for the composite neonatal outcome. Cumulative risk of stillbirth was calculated from 36 weeks until the gestational age at delivery.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S159
ajog.org
BMI 40, BMI 45, as well as weight gain above or below Institute of Medicine (IOM) guidelines were investigated. RESULTS: Of 44 patients during the study period, 28 (63.6%) were maintained at therapeutic anti-Xa levels using weight based dosing, while 16 (36.4%) required dose adjustments. BMI 45.0 was significantly associated with need for dose change based on anti-Xa levels (RR 3.33, 95% CI 2.08, 5.35). All patients with BMI 45.0 needed dosing adjustment to less than their weight based dosage. Other than BMI 45.0, there were no significant risk factors for needing non-weight based dosing (Table). CONCLUSION: Although many patients reach therapeutic anti-Xa levels using weight based dosing of LMWH, more than one-third require non weight based therapy. This suggests that monitoring of antiXa levels after initial weight based dosing for pregnant women requiring therapeutic anticoagulation with LMWH is necessary, particularly among the morbidly obese.
CONCLUSION: Magnesium sulfate exposure near the time of delivery and retreatment with magnesium is associated with reduced odds of cerebral palsy, suggesting timing of prophylaxis is important for neuroprotection. Further studies are needed to determine the optimal magnesium regimen for prevention of cerebral palsy.
Risk factors associated with the need for non-weight based dosing of LMWH based on anti-Xa levels. Risk Factor (n=44)
Patients requiring dosage adjustments and non- Patients receiving weight weight based therapy based therapy (n=16) (n=28)
Relative Risk (95% CI)
BMI ≥ 30.0
9 (56.3%)
19 (67.9%)
0.73 (0.34,1.59)
BMI ≥ 40.0
6 (37.5%)
8 (28.6%)
1.29 (0.58,2.83)
BMI ≥ 45.0
4 (25.0%)
0 (0%)
3.33 (2.08, 5.35)
Weight Gain less than IOM recommendations by BMI
6 (37.5%)
13 (46.4%)
0.79 (0.35,1.79)
Weight Gain over IOM recommendations by BMI
5 (31.5%)
7 (25.0%)
1.21 (0.53,2.76)
270 Characteristics of magnesium sulfate administration and cerebral palsy Gloria Too1, Amy L. Turitz1, Cynthia Gyamfi-Bannerman1 1
Columbia University, New York, NY
OBJECTIVE: In women at risk for preterm delivery, magnesium sulfate
(Mg) reduces the risk of cerebral palsy (CP) in surviving children. The optimal dosing and timing for the prevention of CP have not been clearly defined. Our objective is to evaluate the characteristics of Mg exposure in pregnancies at risk for CP. STUDY DESIGN: This case-control study is a secondary analysis of a multicenter trial evaluating the use of Mg the prevention of CP. We included women with non-anomalous singleton gestations who were exposed to magnesium for neuroprotection during pregnancy and excluded antepartum stillbirths and patients with incomplete outcome ascertainment. Characteristics of magnesium use, including umbilical cord blood Mg level, total grams of Mg, total hours of Mg infusion, Mg exposure within 12 hours of delivery, retreatment after completion of initial Mg course, and infusion at the time of delivery were compared in cases who developed CP and controls who did not. Individual Mg characteristics were adjusted for gestational age at delivery, mode of delivery, and total grams of Mg fitting a logistic regression model. RESULTS: Of the 906 women who received Mg, CP occurred in 28 children (3.09%). Birth weight, gestational age at delivery, and delivery route were different between the groups. The CP group received fewer hours and fewer grams of magnesium. The umbilical cord blood Mg level was similar in the two groups (2.79 vs 2.59, p ¼ 0.51). Retreatment with Mg when delivery was imminent was associated with a significantly decreased risk of CP (Table). There was a trend towards reduced odds of cerebral palsy with magnesium infusion at the time of delivery (OR 0.50, 95% CI 0.23 - 1.08); but this finding was not significantly significant, p ¼ 0.08. On adjusted analyses, Mg exposure within 12 hours of birth associated was also associated with a signification reduction in CP.
271 Is indomethacin associated with perinatal morbidity in the neonate? YeonJung Park1, Eugene Chang1, Tripp Nelson1, Myla D. Ebeling1, Sanjay Patwardhan1 1
Medical University of South Carolina, Charleston, SC
OBJECTIVE: Preterm birth remains a major source of perinatal
morbidity and mortality. Recent studies have demonstrated an increase in the risk of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC) in neonates exposed to indomethacin. The objective of this study is to determine whether indomethacin given for tocolysis at a single institution is associated with an increase in the risk of IVH, PVL, and NEC. STUDY DESIGN: This was a retrospective cohort study of pregnant patients with nonanomalous fetuses delivering between 22-34 weeks who received indomethacin compared to those who did not. The primary outcome studied was composite neonatal morbidity, including grade III/IV IVH, neonatal seizures, PVL, and NEC using data from a research quality database (Perinatal Information Network System (PINS) database) at MUSC. Outcomes were stratified based on gestational age at delivery: 22-24 weeks, 24-26 weeks, 26-28 weeks, 28-32 weeks, and 32-34 weeks gestation. Maternal demographic and additional clinical information were collected. Statistical analysis included chi-square and Student’s t-test where appropriate with 95% confidence intervals and clinical significance determined with a p<0.05. Linear regression modeling was used to determine the significance of exposure of indomethacin with subsequent neonatal morbidity as detailed above. RESULTS: There were 3257 live births between 2009-2013 that were delivered between 22 and 34 weeks and admitted to the newborn nursery. Of these live births, 437 newborns were exposed to antenatal indomethacin and 2820 newborns were not exposed. There was a significant increase in the risk of IVH/PVL with indomethacin. Additionally, there was a greater incidence of NEC, IVH, PVL in the extreme prematurity group (ie between 22-24 weeks, 24-26 weeks). Using logistic regression and controlling for indocin, magnesium sulfate, betamethasone, and gestational age, only lower gestational age was associated with severe IVH, NEC, and PVL.
S158 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
Poster Session II
ajog.org CONCLUSION: Indomethacin does not appear to be an independent
risk factor for IVH, PVL, and NEC when accounting for gestational age at delivery.
272 Shock Index: A potential criterion for a maternal early warning system Catherine S. Eppes1, Jaden Schupp1, Gary Dildy1 1
Baylor College of Medicine, Houston, TX
OBJECTIVE: Postpartum hemorrhage (PPH) is one of the most
common causes of maternal mortality and severe morbidity in the United States and worldwide. The National Partnership for Maternal Safety has proposed development of a Maternal Early Warning Obstetrical Score (MEOWS) based on vital signs to facilitate timely recognition, diagnosis and treatment of women with critical illness. Shock index (SI), calculated as heart rate divided by systolic blood pressure, has been proposed as a metric to predict early hypovolemia and need for transfusion or operative management in trauma settings. We sought to explore how SI relates to PPH and need for transfusion STUDY DESIGN: The SI and delta-SI (peak SI - baseline SI) were calculated for all peripartum vital sign determinations in 50 controls (those without PPH) and 25 cases (those with PPH). Receiver operating characteristic (ROC) curves were plotted for discrimination threshold. Data in table 1 are reported as mean (+/- SD). RESULTS: Descriptive statistics are displayed in table 1. The baseline pre-labor SI was the same for each group. The peak SI differed significantly between controls and cases (p¼0.03). The delta-SI was significantly higher in cases than in controls (p¼0.01). SI was not a sensitive predictor of transfusion, however the delta-SI was highly predictive; a threshold of 0.34 had 91% sensitivity and 90% specificity. Delta-SI was more predictive of need for transfusion then estimated blood loss (ROC area 0.9512 versus 0.9075, p¼0.4), however not significantly. For the 6 patients who required hysterectomy following PPH a delta-SI threshold of 0.373 predicted need for surgical intervention with 100% Sensitivity and 89% specificity. Although limited by small numbers, this difference held true even with the diagnosis of preeclampsia. CONCLUSION: The SI or a variant such as delta-SI may be a valuable predictor of maternal deterioration, the need for transfusion, or operative intervention in the setting of PPH. Shock index and Delta-SI Shock index ControlN=50 All PPH N=25 PPH requiring transfusionsn=8 PPH requiring hysterectomyN=6 Baseline
0.74 +/- 0.13 0.74 +/- 0.13 0.71 +/- 0.21
Labor
0.79 +/- 0.20
0.77 +/- 0.27
Peak
0.88 +/- 0.15 1.28 +/- 0.34 1.20 +/- 0.32
1.3 +/- 0.33
Delta-SI
0.19 +/- 0.23 0.39 +/- 0.24 0.50 +/- 0.20
0.53 +/- 0.20
Maternal and neonatal outcomes. Low-GI Group (69) Group C (62) p-value Gestational diabetes mellitus (GDM)
23 (37.1%)
0.019
Large for gestational age (LGA ≥ 90° centile) 1 (1.4%)
13 (18.8%)
7 (11.3%)
0.019
Pregnancy induced hypertension (PIH)
2 (2.9%)
13 (21%)
0.001
Preterm birth (PTB)
0
5 (8.1%)
0.016
Small for gestational age (SGA ≤ 10° centile) 6 (8.7%)
5 (8.1%)
0.897
Induction of labor
24 (34.8%)
34 (54.8%)
0.021
GWG at 36th week (kg)
9.5±6.4
9.1±6.7
0.749
274 Stillbirth and neonatal adverse outcomes in pregnancies complicated by preexisting and gestational diabetes Alexander M. Friedman1, Cande V. Ananth1, Zainab Siddiq1, Mary E. D’Alton1, Jason D. Wright1 1
Columbia University, New York, NY
OBJECTIVE: The objective of this study was to evaluate the risk for
273 A customized low glycaemic-index (GI) diet prevents both the gestational diabetes mellitus (GDM) and the large for gestational age (LGA) babies in overweight/obese pregnant women Elisabetta Petrella1, Raffaele Bruno1, Giulia Pedrielli1, Valentina Bertarini1, Isabella Neri1, Fabio Facchinetti1 1
trial. Forty-seven refused to participate and 191 were assigned to Intervention (low-GI¼96; low GI-diet of 1800 Kcal/day, prescribed by a dietitian, + 30 minutes walking 3 times/week, measured with pedometer) or Controls (C¼95; lifestyle advices, according to national guidelines). Follow-up (including the gestational weight gainGWG) was planned at 18th, 24nd, 30th and 35th week. At enrollment and at 35th week, Food frequency Questionnaire (FFQ) was filled-in. RESULTS: The socio-demographic characteristics at randomisation were similar. Miscarriages occurred in 6.8%, dropout in 24.6%, leaving at analysis 131 women. Both GDM and LGA were less represented in the low-GI group (Table). According to FFQ, low-GI group showed more adherence (n¼40, 57.9%) respect with C group (n¼24, 38.7%; p:0.028). At logistic regression analysis, the GDM occurrence was explained by both group allocation (OR¼3.9, CI 95%: 1.1-14.4) and lower BMI category (OR¼2.6, CI 95%: 1.1-6.4), after correcting for the confounders (family history of diabetes, age 35 y, Caucasian ethnicity). Significant changes in the consumption of each investigated food were observed only in low-GI group. GWG was similar in both arms. SGA newborns were equally distributed. Low-GI group showed fewer interventions at parturition. CONCLUSION: The current practice of providing general lifestyle advices (through leaflets or directly by providers) is not sufficient to reduce GDM and related complications in overweight/obese women, whereas a customized low-GI diet started early in pregnancy increases the adherence and reduces GDM as well as LGA babies occurrence.
University of Modena and Reggio Emilia, Modena, Italy
OBJECTIVE: To determine whether the prescription/follow-up of a
behavioural program influences the adherence to a healthier lifestyle, thus affecting the GDM occurrence and unfavourable maternal/ neonatal outcomes. STUDY DESIGN: Between the 9-12th week, 238 women with BMI25 were enrolled in a prospective, open-label, randomized controlled
stillbirth and adverse neonatal outcomes in pregnancies complicated by gestational or preexisting diabetes at or nearing term. STUDY DESIGN: This population-based study of U.S. natality records from 2005-2013 evaluated neonatal outcomes and cumulative risk for stillbirth for pregnancies complicated by preexisting and gestational diabetes delivering at 36 weeks gestational age. Only singleton, non-anomalous pregnancies without chronic hypertension and/or preeclampsia/gestational hypertension were included. For delivery at each week of gestation, risk was determined for a composite adverse neonatal outcome that included the following conditions: assisted ventilation for >6 hours, NICU admission, antibiotic administration for suspected neonatal sepsis, surfactant use, neonatal seizures or serious neurologic dysfunction, and/or Apgar score <7 at 5 minutes. Multivariable log-linear regression models were developed to create an adjusted model for the composite neonatal outcome. Cumulative risk of stillbirth was calculated from 36 weeks until the gestational age at delivery.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S159