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302: Chronic hypertension: does prenatal care affect outcomes?
Poster Session II
Hypertension, Diabetes, Prematurity, Physiology
pravastatin treatment (p<0.05). Similar trend was seen at 6 months but the differences did not reach statistical significance. There was no difference in PPAR- g expression between the 3 groups at 3 months. At 6 months of age, PPAR- g expression was higher in sFlt offspring compared with mFc, and was restored to control levels in the sFltprav group (p<0.05). CONCLUSION: In utero exposure to preeclampsia leads to apoptosis in the pancreas followed by compensatory PPAR- g activation to increase insulin secretion. We propose that this process ultimately leads to beta-cell depletion and “burn out” resulting in type II diabetes. Prenatal pravastatin treatment prevents this fetal metabolic programming.
302 Chronic hypertension: does prenatal care affect outcomes? Allison Allen1, Jonathan Snowden1, Bethany Sabol1, Jennifer Salati1, Shireen de Sam Lazro1, Aaron Caughey1 1
Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR
OBJECTIVE: To determine if prenatal care affects adverse perinatal
outcomes in pregnant women with chronic hypertension. STUDY DESIGN: This was a retrospective cohort study of pregnant women with chronic hypertension in the state of California between 1997 and 2006 using vital statistics data linked to birth certificates. Women were stratified by time of presentation to prenatal care and we then compared those women presenting in the first trimester to those presenting in the 3rd trimester. The perinatal outcomes observed included: preeclampsia, preterm delivery, cesarean delivery, gestational diabetes, and intrapartum fetal demise (IUFD). The two groups were compared with chi-squared testing to determine statistical significance. RESULTS: In those women with chronic hypertension who did not present to prenatal care until the 3rd trimester, there was an increased rate of IUFD. Women who presented in the 3rd trimester had a 4.16% risk of IUFD compared to 1% in those who presented in the 1st trimester. There were also increased rates of preeclampsia (36.46% in the 3rd trimester vs 26.8% in the 1st trimester) and preterm birth (32.93% vs 23.7%) in the late presentation to care cohort. There was no difference in the rates of cesarean section between the two groups. Finally, there was a decreased rate of gestational diabetes in the group presenting in the 3rd trimester when compared to the group presenting in the 1st trimester (11.32% vs 18.1%). CONCLUSION: Treatment of chronic hypertension leads to improved maternal and neonatal outcomes.
www.AJOG.org
303 Does race affect glycemic control in gestational diabetes? Johanna Von Hofe1, Alan Tita1, Joseph Biggio1, Lorie Harper1 1 University of Alabama Birmingham, Obstetrics and Gynecology, Birmingham, AL
OBJECTIVE: Black and Hispanic race are known risk factors for
developing gestational diabetes (GDM), and research suggests that birth weight varies by maternal race. However, the influence of race on blood sugar (BS) control in GDM is understudied. Our aim is to elucidate this relationship in order to better counsel and more appropriately manage our heterogeneous patient population. STUDY DESIGN: Retrospective cohort of singleton pregnancies complicated by GDM at a single center from 2007-2012. Subjects with major medical illness, fetal anomalies, and undocumented race were excluded. Maternal race was classified as Non-Hispanic White, Non-Hispanic Black, or Hispanic. All women received diabetic education. The primary outcomes were classification of GDM (A1 vs. A2) and the number of prenatal visits where glycemic control was adequate (<50% of blood sugars above goals). Neonatal outcomes considered were birth weight, large for gestational age (LGA, >90th percentile on Alexander standard), and macrosomia (>4000g). Groups were compared using chi-squared and ANOVA tests. Logistic regression was used to account for confounding variables. RESULTS: 671 subjects were included. Hispanic women were less likely to smoke, have pre-existing hypertension, or be obese then their non-Hispanic counterparts. After adjusting for obesity, Hispanic women were significantly more likely to be diet-controlled than their peers. When Hispanic patients required hypoglycemic agents, they were less likely to be initiated on insulin. Hispanic women had more visits where BS control was adequate and fewer hospital admissions. Despite their improved control, infants of Hispanic women tended to be slightly larger, and there was not a reduction in the risk for macrosomic or LGA infants. CONCLUSION: Hispanic women diagnosed with GDM were more likely to control their BS with diet alone than their White or Black peers. Although less likely to require medications to achieve control, there were no significant differences in the sizes of their infants.
*Referent for AOR is NH White group.
304 1-hour 50 gram glucose challenge (1-hr GCT) values and adverse perinatal outcomes in women without gestational diabetes (GDM) Methodius Tuuli1, Lucy Liu1, Anthony Shanks1, Ryan Longman1, Anthony Odibo1, George Macones1, Alison Cahill1 1
Washington University in St. Louis, Obstetrics & Gynecology, St. Louis, MO
S158 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
Hypertension, Diabetes, Prematurity, Physiology
pravastatin treatment (p<0.05). Similar trend was seen at 6 months but the differences did not reach statistical significance. There was no difference in PPAR- g expression between the 3 groups at 3 months. At 6 months of age, PPAR- g expression was higher in sFlt offspring compared with mFc, and was restored to control levels in the sFltprav group (p<0.05). CONCLUSION: In utero exposure to preeclampsia leads to apoptosis in the pancreas followed by compensatory PPAR- g activation to increase insulin secretion. We propose that this process ultimately leads to beta-cell depletion and “burn out” resulting in type II diabetes. Prenatal pravastatin treatment prevents this fetal metabolic programming.
302 Chronic hypertension: does prenatal care affect outcomes? Allison Allen1, Jonathan Snowden1, Bethany Sabol1, Jennifer Salati1, Shireen de Sam Lazro1, Aaron Caughey1 1
Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR
OBJECTIVE: To determine if prenatal care affects adverse perinatal
outcomes in pregnant women with chronic hypertension. STUDY DESIGN: This was a retrospective cohort study of pregnant women with chronic hypertension in the state of California between 1997 and 2006 using vital statistics data linked to birth certificates. Women were stratified by time of presentation to prenatal care and we then compared those women presenting in the first trimester to those presenting in the 3rd trimester. The perinatal outcomes observed included: preeclampsia, preterm delivery, cesarean delivery, gestational diabetes, and intrapartum fetal demise (IUFD). The two groups were compared with chi-squared testing to determine statistical significance. RESULTS: In those women with chronic hypertension who did not present to prenatal care until the 3rd trimester, there was an increased rate of IUFD. Women who presented in the 3rd trimester had a 4.16% risk of IUFD compared to 1% in those who presented in the 1st trimester. There were also increased rates of preeclampsia (36.46% in the 3rd trimester vs 26.8% in the 1st trimester) and preterm birth (32.93% vs 23.7%) in the late presentation to care cohort. There was no difference in the rates of cesarean section between the two groups. Finally, there was a decreased rate of gestational diabetes in the group presenting in the 3rd trimester when compared to the group presenting in the 1st trimester (11.32% vs 18.1%). CONCLUSION: Treatment of chronic hypertension leads to improved maternal and neonatal outcomes.
www.AJOG.org
303 Does race affect glycemic control in gestational diabetes? Johanna Von Hofe1, Alan Tita1, Joseph Biggio1, Lorie Harper1 1 University of Alabama Birmingham, Obstetrics and Gynecology, Birmingham, AL
OBJECTIVE: Black and Hispanic race are known risk factors for
developing gestational diabetes (GDM), and research suggests that birth weight varies by maternal race. However, the influence of race on blood sugar (BS) control in GDM is understudied. Our aim is to elucidate this relationship in order to better counsel and more appropriately manage our heterogeneous patient population. STUDY DESIGN: Retrospective cohort of singleton pregnancies complicated by GDM at a single center from 2007-2012. Subjects with major medical illness, fetal anomalies, and undocumented race were excluded. Maternal race was classified as Non-Hispanic White, Non-Hispanic Black, or Hispanic. All women received diabetic education. The primary outcomes were classification of GDM (A1 vs. A2) and the number of prenatal visits where glycemic control was adequate (<50% of blood sugars above goals). Neonatal outcomes considered were birth weight, large for gestational age (LGA, >90th percentile on Alexander standard), and macrosomia (>4000g). Groups were compared using chi-squared and ANOVA tests. Logistic regression was used to account for confounding variables. RESULTS: 671 subjects were included. Hispanic women were less likely to smoke, have pre-existing hypertension, or be obese then their non-Hispanic counterparts. After adjusting for obesity, Hispanic women were significantly more likely to be diet-controlled than their peers. When Hispanic patients required hypoglycemic agents, they were less likely to be initiated on insulin. Hispanic women had more visits where BS control was adequate and fewer hospital admissions. Despite their improved control, infants of Hispanic women tended to be slightly larger, and there was not a reduction in the risk for macrosomic or LGA infants. CONCLUSION: Hispanic women diagnosed with GDM were more likely to control their BS with diet alone than their White or Black peers. Although less likely to require medications to achieve control, there were no significant differences in the sizes of their infants.
*Referent for AOR is NH White group.
304 1-hour 50 gram glucose challenge (1-hr GCT) values and adverse perinatal outcomes in women without gestational diabetes (GDM) Methodius Tuuli1, Lucy Liu1, Anthony Shanks1, Ryan Longman1, Anthony Odibo1, George Macones1, Alison Cahill1 1
Washington University in St. Louis, Obstetrics & Gynecology, St. Louis, MO
S158 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014