330: Maternal age and risk of perinatal complications in gravidas with chronic hypertension

Poster Session II 100%) for I PTB subtype, although by birth certificate data 40 patients with I PTB subtype were misclassified as S (FIGURE). The two that were unclassifiable based on birth certificate data were both subtype I by consensus. The most common error for the 40 I PTB misclassification was when delivery was preceded by “premature rupture of membranes >12 hours” based on the birth certificate data. CONCLUSION: Correct classification of PTB subtype into S or I by birth certificate data is unreliable. Clinical information captured on state reported birth data is inadequate for classification of PTB.

ajog.org 0.62 (95% CI (0.51-0.77)], jaundice [OR 0.71 (95% CI (0.55-0.92)], and SGA [OR 0.69 (95% CI (0.50-0.97)]. CONCLUSION: Among pregnancies complicated by chronic hypertension, adolescent maternal age is associated with an increased risk of superimposed preeclampsia and infant death, but decreased risk of preterm delivery, cesarean section, neonatal jaundice, and SGA. These findings suggest a potential association between length of exposure to chronic hypertension and the risk of developing perinatal complications. This relationship should be further explored in future studies. Perinatal complications in women with chronic hypertension by maternal age, (%, *p-value<0.01) Perinatal Complication

Maternal Age <20 years, N=452

Maternal Age 20-35 years, N=12,163

Preterm Delivery

3.98

4.16

Superimposed preeclampsia

39.19*

26.11*

Eclampsia

0.22

0.07

Abruption

1.55

1.69

IUFD

0.88

0.89

Small for Gestational Age (<10th%)

10.77

11.15

Jaundice

20.8*

26.19*

Infant Death

0.89

0.54

Cesarean Delivery

40.93*

49.54*

Induction of Labor

32.96*

28.55*

331 Association of baseline proteinuria with adverse pregnancy outcomes in chronic hypertension 330 Maternal age and risk of perinatal complications in gravidas with chronic hypertension Christina A. Penfield1, Rachel A. Pilliod2, Tania F. Esakoff3, Amy M. Valent4, Aaron B. Caughey4 1

University of California, Irvine, Los Angeles, CA, 2Brigham and Women’s Hospital, Boston, MA, 3Cedars-Sinai Medical Center, Los Angeles, CA, 4 Oregon Health Sciences University, Portland, OR

OBJECTIVE: Chronic hypertension is associated with increased

adverse perinatal outcomes, yet it remains unclear whether maternal age modifies a patient’s risk for these complications. Our study evaluated the influence of adolescent age on the rates of adverse outcomes in pregnancies complicated by chronic hypertension. STUDY DESIGN: This is a retrospective cohort study using 2005-2008 linked hospital discharge and vital statistics records data of live births to women with chronic hypertension in California. Perinatal complications were compared between adolescent women (<20 years old) and adult women (aged 20-35 years) delivering between 24 and 42 weeks gestational age. Maternal outcomes examined include preterm delivery <32 weeks (PTD), superimposed preeclampsia (SPET), eclampsia, abruption, induction of labor (IOL), and cesarean section (CS). Perinatal and neonatal outcomes analyzed were neonatal jaundice, small for gestational age (SGA, defined as 10th percentile for gestational age), intrauterine fetal demise (IUFD), and infant death (within the first year of life). Bivariate and multivariate analyses were performed. RESULTS: We identified 21,959 women with chronic hypertension. Adolescents had higher rates of SPET and IOL, and lower rates of neonatal jaundice and CS than the adult population with chronic hypertension (Table). After controlling for maternal comorbidities and sociodemographic characteristics, adolescent age was an independent risk factor for infant death [OR 3.79 (95% CI (1.22-11.72)], and SPET [OR 1.39 (95% CI (1.17-1.65)], and also independently protective against PTD 0.57 [OR 0.57 (95% CI (0.32-0.99)], CS [OR

Spencer G. Kuper1, Alan T. Tita1, Mallory L. Youngstrom1, Ying Tang1, Joseph R. Biggio1, Lorie M. Harper1 1

University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL

OBJECTIVE: While a urine protein:creatinine (PC) ratio of  0.3 is used to diagnose preeclampsia (PE), there is not an identified baseline PC that predicts the development of adverse outcomes. We examined the association between baseline proteinuria and adverse outcomes in women with chronic hypertension (CHTN). STUDY DESIGN: Retrospective cohort of all singletons with CHTN in a single tertiary center from 2000-2014 with assessment of baseline renal function  20 weeks gestation. Subjects were excluded for creatinine  1.2 mg/dL, anomalous fetuses and major medical problems other than diabetes. The primary outcome was PE with severe features <34 weeks. Secondary outcomes were severe PE at any gestational age (GA), any PE, preterm birth (PTB) < 35 weeks, composite neonatal outcome (perinatal death, assisted ventilation, cord pH < 7, 5-minute Apgar  3 and neonatal seizures) and small for gestational age (SGA). PE was defined by ACOG definitions requiring either proteinuria or abnormal serum labs in addition to hypertension. Receiver-operating characteristic (ROC) curves were used to estimate the association between baseline PC and the primary outcome. The Liu method was used to objectively determine a cut-point for PC; outcomes were compared between those with PC values above and below the cut-point using univariate and multivariate analyses. RESULTS: 739 women with CHTN had assessment of PC  20 completed weeks of gestation. The area under the ROC curve for early onset severe PE in women was 0.74(95%CI 0.65-0.83). The PC Liu cut-point for the development of severe PE was  0.12, which had a sensitivity and specificity of 69.6 and 76.5%, respectively. A PC  0.12 was significantly associated with an increased risk of any type of PE and PTB < 35 weeks. CONCLUSION: A baseline PC  0.12 in patients with CHTN and normal creatinine is associated with development of PE and PTB.

S186 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016