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361: Sensitivity of prenatal ultrasound for detection of trisomy 18
Poster Session II
ajog.org 360 Maternal childhood disadvantage, hair cortisol, and small-for-gestational-age birth
361 Sensitivity of prenatal ultrasound for detection of trisomy 18
Ann Borders1,2, Lauren Keenan-Devlin3, Emma Adam4,5, Greg Miller6,7, Jennifer Culhane8,9, Pathik Wadhwa10, Claudia Buss10,11, Sonja Entringer10,11, Kristine Kuchta12, Kwang-Youn Kim13, Hyagriv Simhan14,15, Doug Williamson16, William Grobman2,17
David Becker1, Ying Tang1, Adam P. Jacobs1, Joseph R. Biggio1, Rodney K. Edwards2, Akila Subramaniam1
1 NorthShore University HealthSystem Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; University of Chicago Pritzker School of Medicine, Evanston, IL, 2Northwestern University Center for Healthcare Studies e Institute for Public Health and Medicine, Chicago, IL, 3NorthShore University HealthSystem Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Evanston, IL, 4 Northwestern University, School of Education and Social Policy, Evanston, IL, 5Northwestern University Institute for Policy Research, Evanston, IL, 6 Northwestern University Department of Psychology, Evanston, IL, 7 Northwestern University Department of Psychology; Institute for Policy Research, Evanston, IL, 8Children’s Hospital of Philadelphia, Division of Adolescent Medicine, Philadelphia, PA, 9University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA, 10UCI Development, Health and Disease Research Program, University of California Irvine, Irvine, CA, 11Charité, Universitätsmedizin Berlin, Berlin, Germany, 12 Northshore University Healthsystem, Research Institute, Center for Biomedical Research Informatics, Evanston, IL, 13Northwestern University Feinberg School of Medicine Department of Preventative Medicine, Biostatistics, Chicago, IL, 14University of Pittsburgh School of Medicine, Division of Maternal-Fetal Medicine, Pittsburgh, PA, 15Magee Women’s Hospital, Division of Obstetrical Services, Pittsburgh, PA, 16Duke University, Department of Psychiatry and Behavioral Services, Durham, NC, 17 Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Chicago, IL
OBJECTIVE: Individuals exposed to childhood disadvantage (CD) may
experience altered HPA-axis activity, with possible long-term health consequences that may be transmitted across generations. We determined whether maternal past exposure to CD is associated with increased hair cortisol during pregnancy and risk of small-forgestational age (SGA) at birth. STUDY DESIGN: A multi-site prospective study was conducted in pregnant women. CD was assessed using 8 items from the “Questions about your Childhood” survey that assessed availability of specific household possessions when growing up. CD was quantified by summing the number of deficits, and 4 groups were created: no disadvantage (52%), 1 disadvantage (23%), 2 disadvantages (15%), and 3+ disadvantages (11%). Cortisol was measured in hair samples collected from 574 women between 12-21 weeks gestation. Obstetric outcomes were abstracted from the medical record. SGA was defined as less than 10th percentile birth weight for gestational age adjusted for infant sex and parity. The associations between CD, hair cortisol, and SGA were determined using linear and logistic regression and mediation analysis. RESULTS: In unadjusted models, history of CD was associated with higher hair cortisol concentrations (b¼0.091; 95% CI 0.01-0.15; p¼0.028) and increased odds of SGA (OR¼1.41; 95% CI 1.1-1.8). Hair cortisol also was associated with increased risk of SGA (OR¼1.39; 95% CI 1.1-1.9), but cortisol did not mediate the relationship between CD and SGA. Associations between CD and SGA, and those between hair cortisol and SGA, remained significant when adjusting for current income, age, race, obstetric complications, and smoking status; the relationship between CD and hair cortisol was not significant (p¼0.061) in adjusted models. CONCLUSION: CD is associated with SGA birth, and this association is not mediated by maternal cortisol concentrations. This finding highlights that CD is associated with adverse pregnancy outcomes that may have both long-term and intergenerational adverse health consequences.
1
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL, 2 University of Oklahoma, Oklahoma City, OK
OBJECTIVE: The sensitivity of prenatal ultrasound (US) to detect
trisomy 18 (T18) is reported to be 80-90%, but past studies have been limited by sample size. Given improvement in US technology, we sought to evaluate the sensitivity of prenatal US for T18 diagnosis and describe US findings at various gestational ages (GA). STUDY DESIGN: We conducted a retrospective study of all cases of T18 diagnosed at our institution from October 2004-October 2014 based on amniocentesis, chorionic villus sampling, cell-free DNA screening which was confirmed postnatally, or postnatal neonatal blood sampling. Patients had a first trimester and/or targeted second trimester US performed by maternal-fetal medicine specialists at our institution. US findings were reviewed, classified by organ system, and categorized as an anomaly or soft marker. GA at which individual findings were detected was recorded. Chi-square or t-test was used for statistical analysis. RESULTS: 128 cases of T18 met inclusion criteria, 110 (86%) of which were diagnosed prenatally. 121 (95%) had at least one abnormal US finding, with the initial finding detected at a mean (SD) GA of 20.15.0 weeks. While there was no difference in timing of detection of any US finding (anomaly or marker), anomalies were more frequently identified on US at 20 weeks’ vs. <20 weeks’ GA (93% vs. 76%; p¼0.004). Brain and cardiac anomalies were the most common organ systems involved (Table). Abdominal and neck abnormalities were more likely to be detected <20 weeks’ GA; whereas cardiac, urologic, growth, and amniotic fluid abnormalities were more likely to be detected 20 weeks’ GA. The mean number of findings detected per fetus was 5.13.0. Fetuses diagnosed postnatally had a similar number of ultrasound exams performed compared to those diagnosed prenatally (mean 2.5 vs 1.9; p¼0.06). There was also a similar number of abnormal ultrasound findings in those diagnosed prenatally compared to those diagnosed postnatally (mean 5.2 vs 4.8; p¼0.63). CONCLUSION: Nineteen of every twenty fetuses with T18 have at least one abnormal US finding. Anomalies and markers are observed in all organ systems, with the timing of detection dependent on organ system involved. This sensitivity of prenatal detection of T18 on ultrasound is higher than has conventionally been reported in the literature and should be considered when providing prenatal counseling.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S219
ajog.org 360 Maternal childhood disadvantage, hair cortisol, and small-for-gestational-age birth
361 Sensitivity of prenatal ultrasound for detection of trisomy 18
Ann Borders1,2, Lauren Keenan-Devlin3, Emma Adam4,5, Greg Miller6,7, Jennifer Culhane8,9, Pathik Wadhwa10, Claudia Buss10,11, Sonja Entringer10,11, Kristine Kuchta12, Kwang-Youn Kim13, Hyagriv Simhan14,15, Doug Williamson16, William Grobman2,17
David Becker1, Ying Tang1, Adam P. Jacobs1, Joseph R. Biggio1, Rodney K. Edwards2, Akila Subramaniam1
1 NorthShore University HealthSystem Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine; University of Chicago Pritzker School of Medicine, Evanston, IL, 2Northwestern University Center for Healthcare Studies e Institute for Public Health and Medicine, Chicago, IL, 3NorthShore University HealthSystem Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Evanston, IL, 4 Northwestern University, School of Education and Social Policy, Evanston, IL, 5Northwestern University Institute for Policy Research, Evanston, IL, 6 Northwestern University Department of Psychology, Evanston, IL, 7 Northwestern University Department of Psychology; Institute for Policy Research, Evanston, IL, 8Children’s Hospital of Philadelphia, Division of Adolescent Medicine, Philadelphia, PA, 9University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA, 10UCI Development, Health and Disease Research Program, University of California Irvine, Irvine, CA, 11Charité, Universitätsmedizin Berlin, Berlin, Germany, 12 Northshore University Healthsystem, Research Institute, Center for Biomedical Research Informatics, Evanston, IL, 13Northwestern University Feinberg School of Medicine Department of Preventative Medicine, Biostatistics, Chicago, IL, 14University of Pittsburgh School of Medicine, Division of Maternal-Fetal Medicine, Pittsburgh, PA, 15Magee Women’s Hospital, Division of Obstetrical Services, Pittsburgh, PA, 16Duke University, Department of Psychiatry and Behavioral Services, Durham, NC, 17 Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Chicago, IL
OBJECTIVE: Individuals exposed to childhood disadvantage (CD) may
experience altered HPA-axis activity, with possible long-term health consequences that may be transmitted across generations. We determined whether maternal past exposure to CD is associated with increased hair cortisol during pregnancy and risk of small-forgestational age (SGA) at birth. STUDY DESIGN: A multi-site prospective study was conducted in pregnant women. CD was assessed using 8 items from the “Questions about your Childhood” survey that assessed availability of specific household possessions when growing up. CD was quantified by summing the number of deficits, and 4 groups were created: no disadvantage (52%), 1 disadvantage (23%), 2 disadvantages (15%), and 3+ disadvantages (11%). Cortisol was measured in hair samples collected from 574 women between 12-21 weeks gestation. Obstetric outcomes were abstracted from the medical record. SGA was defined as less than 10th percentile birth weight for gestational age adjusted for infant sex and parity. The associations between CD, hair cortisol, and SGA were determined using linear and logistic regression and mediation analysis. RESULTS: In unadjusted models, history of CD was associated with higher hair cortisol concentrations (b¼0.091; 95% CI 0.01-0.15; p¼0.028) and increased odds of SGA (OR¼1.41; 95% CI 1.1-1.8). Hair cortisol also was associated with increased risk of SGA (OR¼1.39; 95% CI 1.1-1.9), but cortisol did not mediate the relationship between CD and SGA. Associations between CD and SGA, and those between hair cortisol and SGA, remained significant when adjusting for current income, age, race, obstetric complications, and smoking status; the relationship between CD and hair cortisol was not significant (p¼0.061) in adjusted models. CONCLUSION: CD is associated with SGA birth, and this association is not mediated by maternal cortisol concentrations. This finding highlights that CD is associated with adverse pregnancy outcomes that may have both long-term and intergenerational adverse health consequences.
1
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL, 2 University of Oklahoma, Oklahoma City, OK
OBJECTIVE: The sensitivity of prenatal ultrasound (US) to detect
trisomy 18 (T18) is reported to be 80-90%, but past studies have been limited by sample size. Given improvement in US technology, we sought to evaluate the sensitivity of prenatal US for T18 diagnosis and describe US findings at various gestational ages (GA). STUDY DESIGN: We conducted a retrospective study of all cases of T18 diagnosed at our institution from October 2004-October 2014 based on amniocentesis, chorionic villus sampling, cell-free DNA screening which was confirmed postnatally, or postnatal neonatal blood sampling. Patients had a first trimester and/or targeted second trimester US performed by maternal-fetal medicine specialists at our institution. US findings were reviewed, classified by organ system, and categorized as an anomaly or soft marker. GA at which individual findings were detected was recorded. Chi-square or t-test was used for statistical analysis. RESULTS: 128 cases of T18 met inclusion criteria, 110 (86%) of which were diagnosed prenatally. 121 (95%) had at least one abnormal US finding, with the initial finding detected at a mean (SD) GA of 20.15.0 weeks. While there was no difference in timing of detection of any US finding (anomaly or marker), anomalies were more frequently identified on US at 20 weeks’ vs. <20 weeks’ GA (93% vs. 76%; p¼0.004). Brain and cardiac anomalies were the most common organ systems involved (Table). Abdominal and neck abnormalities were more likely to be detected <20 weeks’ GA; whereas cardiac, urologic, growth, and amniotic fluid abnormalities were more likely to be detected 20 weeks’ GA. The mean number of findings detected per fetus was 5.13.0. Fetuses diagnosed postnatally had a similar number of ultrasound exams performed compared to those diagnosed prenatally (mean 2.5 vs 1.9; p¼0.06). There was also a similar number of abnormal ultrasound findings in those diagnosed prenatally compared to those diagnosed postnatally (mean 5.2 vs 4.8; p¼0.63). CONCLUSION: Nineteen of every twenty fetuses with T18 have at least one abnormal US finding. Anomalies and markers are observed in all organ systems, with the timing of detection dependent on organ system involved. This sensitivity of prenatal detection of T18 on ultrasound is higher than has conventionally been reported in the literature and should be considered when providing prenatal counseling.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S219