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455: Effects of maternal sleep apnea on fetal growth
Poster Session III
ajog.org
Table: a) Fetal intervention vs. expectant management in NIHF with unknown etiology, b) Fetal intervention vs. expectant management in NIHF with unknown etiology with pleural effusion. Table a.
Fetal intervention (n=14)
Expectant management (n=42)
P value
Gestational Age at delivery, N (%)
32.8 ± 2.1
32.7 ± 4.0
0.29
Survival to discharge, N (%)
7(50%)
26 (61.9%)
0.36
Death at 30 days, N (%)
5(35.7%)
11 (26.1%)
0.34
Table b.
Fetal intervention in fetuses with pleural effusion (n=12)
Expectant managemet in fetuses with pleural effusion (n=21)
P value
Gestational Age at delivery, N (%)
32.8 ± 2.4
32.8 ± 3.7
0.20
Survival to discharge, N (%)
6(50%)
12(57.1%)
0.69
Death at 30 days N (%)
4 (33.3%)
6(28.5%)
1.00
454 Small for gestational age at term: an independent risk factor for long-term pediatric morbidity Efrat Spiegel1, Ilana Shoham-Vardi2, Ruslan Sergienko2, Daniella Landau1, Eyal Sheiner1 1
Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel, 2Ben Gurion University of the Negev, Beer Sheva, Israel
OBJECTIVE: To investigate whether being delivered small for gesta-
tional age (SGA) at term poses an increased risk for long-term pediatric morbidity. STUDY DESIGN: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to cardiovascular, hematologic, respiratory, neurological and urinary morbidity of children born SGA at term (37-42 weeks gestation). Deliveries occurred between the years 1991-2014 in a tertiary medical center. Congenital malformations as well as multiple pregnancies were excluded. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters. RESULTS: During the study period 236,504 deliveries met the inclusion criteria; of which 4.8% were SGA neonates (n¼11,319). During the follow-up period, children born SGA at term had a significantly higher rate of long-term cardiovascular, hematologic and respiratory morbidity (table). Using multivariable GEE logistic regression models, controlling for the time-to-event, maternal age and maternal diabetes mellitus, being born SGA at term was found to be an independent risk factor for long-term cardiovascular, hematologic and respiratory disease during childhood (table). CONCLUSION: Being delivered SGA at term is an independent risk factor for long-term cardiovascular, hematologic and respiratory morbidity of the offspring. Morbidity of children born SGA compared to children born not SGA Morbidity
SGA (n=11,319) Not SGA (n=225,185) Adjusted OR 95% CI p-value
Cardiovascular 0.3%
0.2%
1.5
1.1-2.1 0.017
Hematologic
1.0%
1.5
1.2-1.7 < 0.001
1.4%
Respiratory
6.3%
5.5%
1.2
1.1-1.3 < 0.001
Neurological
1.0%
0.9%
1.1
0.9-1.3 0.259
Urinary
0.8%
0.6%
1.2
0.9-1.5 0.114
455 Effects of maternal sleep apnea on fetal growth Anna W. Kneitel1, Marjorie C. Treadwell1, Louise M. O’Brien1 1
University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI
OBJECTIVE: The objective of this study was to investigate whether
maternal obstructive sleep apnea (OSA) is associated with differences in fetal growth. STUDY DESIGN: This is a secondary analysis of fetal growth in women with singleton gestations who underwent overnight
polysomnography as part of several prospective studies investigating the relationship of OSA to adverse pregnancy outcomes. Snoring and non-snoring women were eligible, as were those with comorbidities. Subjects were excluded if they were currently receiving treatment for OSA. Fetal growth was estimated using sonographic biometric measurements obtained during routine prenatal care. GROW software was used to calculate customized estimated fetal weight (EFW) and birth weight centiles adjusted for maternal height, weight, ethnicity, parity, and fetal gender. Fetal growth problems were defined as birth weight less than the 10th centile, or a slowing of fetal growth by more than 30% during the last trimester. OSA was considered present when the apnea/hypopnea index (a measure of respiratory disturbance per hour of sleep) was at least 5/hr. RESULTS: Overall, 88 women participated with a mean maternal age of 32.36.8 years and a median gestational age of 33.0 weeks at the time of polysomnography. Twelve women (14%) had a diagnosis of pre-eclampsia and n¼10 women (11%) had gestational diabetes. A birth weight of less than the 10th centile was observed in n¼21 infants, while n¼41 had fetal growth problems. In total, n¼34 women (39%) had OSA which ranged in severity from AHI 5-140 (median AHI 7.7). In a logistic regression model, after accounting for co-morbid hypertension, diabetes, anti-hypertensives and antidiabetic medications, maternal age, and smoking, the presence of OSA was associated with a 3-fold increased risk of fetal growth problems (OR 3.0, 95%CI 1.1-8.3, p¼0.03). CONCLUSION: Obstructive sleep apnea is independently associated with altered fetal growth. Future studies focusing on treatment for OSA will help determine whether this is a causative relationship that is reversible with appropriate therapy.
456 Predicting normal pH with Intrapartum electronic fetal monitoring (EFM) Alison G. Cahill1, Methodius G. Tuuli1, Molly J. Stout1, Elena Deych1, William Shannon1, George A. Macones1 1
Washington University in St. Louis, Saint Louis, MO
OBJECTIVE: EFM is almost universally as a screening test for acidemia
in labor. However, as important is the ability to predict normal pH and thus avoid unnecessary interventions. We aimed to estimate EFM patterns associated with normal pH ( 7.20). STUDY DESIGN: This was a prospective cohort study of all consecutive women with a cephalic singleton in labor at 37 weeks gestation between 2010-2014. Continuous EFM and arterial cord gas (ACG) were inclusion criteria, both universal at the study site. EFM patterns during the 2 hours prior to delivery were interpreted in 10-minute epochs by trained obstetric research nurses, blind to clinical data including pH, with previously published high reproducibility. Accelerations were considered present if spontaneous or induced. Final regression models adjusted for nulliparity, pregestational diabetes, and advanced maternal age. Area under the receiver-operator characteristic curves (AUC) and test characteristics were used to estimate and compare the predictive efficiency of EFM patterns. RESULTS: Of 8,580 women in labor, 149 (1.7%) delivered infants with acidemia. Compared to Category I, combinations of EFM features were significantly more discriminatory for normal pH; specifically, baseline and accelerations were the most predictive. The model with one or more accelerations and never tachycardia performed the best (AUC¼0.741) with a negative predictive value (NPV) of 0.993. Ever Category I (AUC¼0.647) or Mostly Category I (AUC¼0.623) alone had the lowest predictive ability, though all models had a high NPV (Table). More than one acceleration did not improve the AUC.
S250 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org
Table: a) Fetal intervention vs. expectant management in NIHF with unknown etiology, b) Fetal intervention vs. expectant management in NIHF with unknown etiology with pleural effusion. Table a.
Fetal intervention (n=14)
Expectant management (n=42)
P value
Gestational Age at delivery, N (%)
32.8 ± 2.1
32.7 ± 4.0
0.29
Survival to discharge, N (%)
7(50%)
26 (61.9%)
0.36
Death at 30 days, N (%)
5(35.7%)
11 (26.1%)
0.34
Table b.
Fetal intervention in fetuses with pleural effusion (n=12)
Expectant managemet in fetuses with pleural effusion (n=21)
P value
Gestational Age at delivery, N (%)
32.8 ± 2.4
32.8 ± 3.7
0.20
Survival to discharge, N (%)
6(50%)
12(57.1%)
0.69
Death at 30 days N (%)
4 (33.3%)
6(28.5%)
1.00
454 Small for gestational age at term: an independent risk factor for long-term pediatric morbidity Efrat Spiegel1, Ilana Shoham-Vardi2, Ruslan Sergienko2, Daniella Landau1, Eyal Sheiner1 1
Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel, 2Ben Gurion University of the Negev, Beer Sheva, Israel
OBJECTIVE: To investigate whether being delivered small for gesta-
tional age (SGA) at term poses an increased risk for long-term pediatric morbidity. STUDY DESIGN: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to cardiovascular, hematologic, respiratory, neurological and urinary morbidity of children born SGA at term (37-42 weeks gestation). Deliveries occurred between the years 1991-2014 in a tertiary medical center. Congenital malformations as well as multiple pregnancies were excluded. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters. RESULTS: During the study period 236,504 deliveries met the inclusion criteria; of which 4.8% were SGA neonates (n¼11,319). During the follow-up period, children born SGA at term had a significantly higher rate of long-term cardiovascular, hematologic and respiratory morbidity (table). Using multivariable GEE logistic regression models, controlling for the time-to-event, maternal age and maternal diabetes mellitus, being born SGA at term was found to be an independent risk factor for long-term cardiovascular, hematologic and respiratory disease during childhood (table). CONCLUSION: Being delivered SGA at term is an independent risk factor for long-term cardiovascular, hematologic and respiratory morbidity of the offspring. Morbidity of children born SGA compared to children born not SGA Morbidity
SGA (n=11,319) Not SGA (n=225,185) Adjusted OR 95% CI p-value
Cardiovascular 0.3%
0.2%
1.5
1.1-2.1 0.017
Hematologic
1.0%
1.5
1.2-1.7 < 0.001
1.4%
Respiratory
6.3%
5.5%
1.2
1.1-1.3 < 0.001
Neurological
1.0%
0.9%
1.1
0.9-1.3 0.259
Urinary
0.8%
0.6%
1.2
0.9-1.5 0.114
455 Effects of maternal sleep apnea on fetal growth Anna W. Kneitel1, Marjorie C. Treadwell1, Louise M. O’Brien1 1
University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI
OBJECTIVE: The objective of this study was to investigate whether
maternal obstructive sleep apnea (OSA) is associated with differences in fetal growth. STUDY DESIGN: This is a secondary analysis of fetal growth in women with singleton gestations who underwent overnight
polysomnography as part of several prospective studies investigating the relationship of OSA to adverse pregnancy outcomes. Snoring and non-snoring women were eligible, as were those with comorbidities. Subjects were excluded if they were currently receiving treatment for OSA. Fetal growth was estimated using sonographic biometric measurements obtained during routine prenatal care. GROW software was used to calculate customized estimated fetal weight (EFW) and birth weight centiles adjusted for maternal height, weight, ethnicity, parity, and fetal gender. Fetal growth problems were defined as birth weight less than the 10th centile, or a slowing of fetal growth by more than 30% during the last trimester. OSA was considered present when the apnea/hypopnea index (a measure of respiratory disturbance per hour of sleep) was at least 5/hr. RESULTS: Overall, 88 women participated with a mean maternal age of 32.36.8 years and a median gestational age of 33.0 weeks at the time of polysomnography. Twelve women (14%) had a diagnosis of pre-eclampsia and n¼10 women (11%) had gestational diabetes. A birth weight of less than the 10th centile was observed in n¼21 infants, while n¼41 had fetal growth problems. In total, n¼34 women (39%) had OSA which ranged in severity from AHI 5-140 (median AHI 7.7). In a logistic regression model, after accounting for co-morbid hypertension, diabetes, anti-hypertensives and antidiabetic medications, maternal age, and smoking, the presence of OSA was associated with a 3-fold increased risk of fetal growth problems (OR 3.0, 95%CI 1.1-8.3, p¼0.03). CONCLUSION: Obstructive sleep apnea is independently associated with altered fetal growth. Future studies focusing on treatment for OSA will help determine whether this is a causative relationship that is reversible with appropriate therapy.
456 Predicting normal pH with Intrapartum electronic fetal monitoring (EFM) Alison G. Cahill1, Methodius G. Tuuli1, Molly J. Stout1, Elena Deych1, William Shannon1, George A. Macones1 1
Washington University in St. Louis, Saint Louis, MO
OBJECTIVE: EFM is almost universally as a screening test for acidemia
in labor. However, as important is the ability to predict normal pH and thus avoid unnecessary interventions. We aimed to estimate EFM patterns associated with normal pH ( 7.20). STUDY DESIGN: This was a prospective cohort study of all consecutive women with a cephalic singleton in labor at 37 weeks gestation between 2010-2014. Continuous EFM and arterial cord gas (ACG) were inclusion criteria, both universal at the study site. EFM patterns during the 2 hours prior to delivery were interpreted in 10-minute epochs by trained obstetric research nurses, blind to clinical data including pH, with previously published high reproducibility. Accelerations were considered present if spontaneous or induced. Final regression models adjusted for nulliparity, pregestational diabetes, and advanced maternal age. Area under the receiver-operator characteristic curves (AUC) and test characteristics were used to estimate and compare the predictive efficiency of EFM patterns. RESULTS: Of 8,580 women in labor, 149 (1.7%) delivered infants with acidemia. Compared to Category I, combinations of EFM features were significantly more discriminatory for normal pH; specifically, baseline and accelerations were the most predictive. The model with one or more accelerations and never tachycardia performed the best (AUC¼0.741) with a negative predictive value (NPV) of 0.993. Ever Category I (AUC¼0.647) or Mostly Category I (AUC¼0.623) alone had the lowest predictive ability, though all models had a high NPV (Table). More than one acceleration did not improve the AUC.
S250 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016