450: Is there an association between recurrent pregnancy loss and future risk for ophthalmic complications?

Poster Session III

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450 Is there an association between recurrent pregnancy loss and future risk for ophthalmic complications? Ron Charach1, Roi Kessous1, Ofer Beharier1, Ehud Davidson1, Eyal Sheiner1 1

Soroka university hospital, Beer sheva, Israel

OBJECTIVE: To investigate whether patients with a history of recur-

rent pregnancy loss (RPL) have an increased risk for subsequent long-term ophthalmic complications. STUDY DESIGN: A population-based study compared the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a history of RPL (defined as 2 or more consecutive pregnancy losses). Deliveries occurred between the years 1988-2013 in a tertiary medical center, with a mean follow-up duration of 12 years. Women with known ophthalmic diseases prior to (or during) the index pregnancy were excluded from the study. Ophthalmic complications were divided to glaucoma, diabetic retinopathy, macular degeneration and retinal detachment. Kaplan-Meier survival curve was used to estimate cumulative incidence of ophthalmic complications. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for ophthalmic complications. RESULTS: During the study period 106,249 deliveries met the inclusion criteria; 6.6% (n¼7051) occurred in patients with a history of RPL. Using a Kaplan-Meier survival curve, patients with a history of RPL had a significantly higher cumulative incidence of ophthalmic complications (Figure). Patients with RPL had a significantly higher incidence of long-term ophthalmic complications in general; however, when analyzed separately, no specific type of ophthalmic complication remained statistically significant (Table). Using a Cox proportional hazards model, adjusted for confounders such as preeclampsia, diabetes mellitus and parity, a history of RPL remained independently associated with ophthalmic complications (adjusted HR, 1.5; 95% CI, 1.01-2.2; P¼0.042). CONCLUSION: Recurrent pregnancy loss is an independent risk factor for long-term maternal ophthalmic complications. Ophthalmic complications in patients with and without recurrent pregnancy loss RPL(n= 7051) No RPL(n= 99,198) OR 95% CI

P value

Glaucoma

0.04%

0.03%

1.5 0.5-5.0

0.496

Diabetic retinopathy

0.09%

0.05%

1.8 0.8-4.2

0.171

Macular degeneration 0.01%

0.01%

1.6 0.2-12.3 0.669

Retinal detachment

0.2%

0.1%

1.7 0.9-3.1

0.099

Total

0.4%

0.2%

1.8 1.2-2.7

0.002

451 Progesterone, cervical cerclage and cervical pessary for primary prevention of preterm birth in high risk singleton pregnancies: a systematic review and network meta-analysis Alexander Jarde1, Olha Lutsiv1, Christina Park1, Metin Gulmezoglu2, Prakesh Shah3, Anne Biringer3, Shigeru Saito4, Jocelynn Cook5, Claudio Vera6, Jon Barrett3, Jean Chamberlain7, Jodie Dodd8, Lucia Giglia1, Maite Lopez-Yarto9, William Mundle10, Tonia Occhionero11, Lisa Sabatino12, Katharina Staub13, Zhen Han14, Yi Wang1, Julie Yu1, Joseph Beyene1, Sarah D. McDonald1 1 McMaster University, Hamilton, ON, Canada, 2World Health Organization/ Organisation mondiale de la santé, Geneva, Switzerland, 3University of Toronto, Toronto, ON, Canada, 4University of Toyama, Toyama, Japan, 5The Society of Obestetricians and Gynaecologists of Canada, Ottawa/La La Société des obstétriciens et gynécologues du Canada, Ottawa, Ottawa, ON, Canada, 6 Pontificia Universidad Católica de Chile, Santiago, Chile, 7Uganda Christian University, Mukono, Uganda, 8University of Adelaide, Adelaide, Australia, 9 Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain, 10 Windsor Regional Hospital, Windsor, ON, Canada, 11Canadian Association of Midwives, Montreal, QC, Canada, 12Hamilton Health Sciences, Hamilton, ON, Canada, 13Canadian Premature Babies Foundation, Sherwood Park, AB, Canada, 14First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

OBJECTIVE: To determine the relative treatment effects of progester-

one, cervical cerclage and cervical pessary for primary prevention of preterm birth in high risk singleton pregnancies, and to rank them in a clinically meaningful hierarchy. STUDY DESIGN: We searched 5 electronic databases (Medline, Embase, Cinahl, Cochrane Central Register of Controlled Trials and Web of Science) for randomized controlled trials comparing progesterone, cerclage and pessary to a control group or each other. Primary outcomes were preterm birth at <37 and <34 weeks. Direct and indirect comparisons were combined using Bayesian network metaanalyses resulting in network effect estimates along with credible intervals (CrI), the Bayesian equivalent of confidence intervals. The interventions were ranked in terms of efficacy based on the surface under the cumulative ranking curve (SUCRA). Heterogeneity and incoherence were assessed using I2 and node-splitting, respectively. RESULTS: Of 12,136 citations, 40 trials were included with 11,637 women. Our preliminary analyses showed that the most effective treatment for preventing preterm birth <37 weeks was pessary (OR

S248 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016