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467: Frequency of cervical length surveillance in high-risk women based on initial cervical length
Poster Session III
Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues
OBJECTIVE: Exposure to inflammation-induced preterm birth (IIPB) is known to lead to long-term neurodevelopmental disabilities in offspring. We have previously demonstrated in a mouse model of IIPB that maternal administration of human adipose-derived mesenchymal stem cells (MSC) modulates the maternal and fetal immune response to intrauterine inflammation and decreases preterm birth rate. The objective of this study was to investigate the effect of MSC on offspring neurodevelopment and to construct possible mechanisms. STUDY DESIGN: A mouse model of IIPB was utilized, with 49 dams in 3 treatment groups: 1) negative control-intrauterine (IU) normal saline (NS); 2) positive control - IU lipopolysaccharide (LPS); and 3) IU LPS + IP MSC, administered 15 h prior to the onset of inflammation. Maternal spleen (MS), placentas and fetal brains were collected. Immunohistochemistry (HuNu, DAPI and CD44) was performed for localization and MSC count. Multiplex ELISA for protein levels of IL-1b, IL6, TNFa, IL12, INFg, IL-2, IL4, IL5 and IL10 was performed. A standardized murine behavioral scoring system (battery of 7 tests) was used to evaluate neurologic outcomes at postnatal days (PND) 5, 9 and 13. Standard statistics were employed. RESULTS: MSC administration improved behavioral phenotype as early as PND5 (p<0.001, ANOVA). MSC localized to placenta at 10x greater concentration than MS. These findings were associated with increase in IL-2 and IL-4 in placenta in the LPS+MSC as compared to LPS group (p<0.05 for both). CONCLUSION: Maternal administration of MSC was associated with improved neurobehavioral development in the group exposed to intrauterine inflammation. We speculate that the adverse effects of intrauterine inflammation were blocked by MSC through immunomodulation in placenta, possibly implicating a role of placental immune response to inflammation in perinatal brain injury.
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maintained CL 25 mm. The covariate-adjusted ROC curve had moderate predictive value (AUC ¼ 0.753), but did not identify a discernible cut point. Evaluation of various CL cutoffs demonstrated that a CL 39 mm had the greatest negative predictive value (85.1%). No cut point existed above which there was no CL shortening, although at 39 mm only 2 patients (1.1%) shortened within 2 weeks (p < 0.001) (Figure). CONCLUSION: In high-risk patients whose initial CL is at least 39 mm, CL shortening <25 mm is uncommon in the following 2 weeks. Therefore, patients with CL greater than this threshold may require less frequent CL surveillance.
Kaplan-Meier plot of time to CL shortening or delivery based on initial CL 39mm at first ultrasound (log-rank p<0.001)
Test characteristics of various CL cut points identified in the ROC analysis
467 Frequency of cervical length surveillance in high-risk women based on initial cervical length Akila Subramaniam1, Lorie Harper1, Jeffery Szychowski2, John Owen1 1 University of Alabama at Birmingham, Division of Maternal-Fetal Medicine, Birmingham, AL, 2University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL
OBJECTIVE: Shortened cervical length (CL) assessed by transvaginal ultrasound is a major predictor of spontaneous preterm birth (SPTB), for which effective interventions are available. Since the natural history of CL shortening has not been well-characterized, serial mid-trimester CL assessment is performed in high-risk patients. We sought to estimate the predictive value of the initial CL for subsequent shortening <25 mm. STUDY DESIGN: We conducted a secondary analysis of a multi-center randomized trial of high-risk women (prior SPTB < 34 weeks) with CL screening at least every 2 weeks from 160/7- 226/7 weeks. Our primary outcome was CL <25 mm or delivery prior to a second follow-up CL sonogram. The risk of CL shortening was analyzed by initial CL (at 16-18 weeks). Logistic regression was used to estimate the effect of initial CL on the risk of shortening while adjusting for confounders, and a receiver operator characteristics (ROC) curve was created to identify an ideal threshold value for the absence of later shortening. Kaplan-Meier curves were used to assess the time to CL <25 mm, based on initial CL. RESULTS: 786 high-risk women were identified in the primary RCT197 with CL shortening < 23 weeks (25.0%), 3 with delivery within 2 weeks of initial ultrasound (0.4%), and 586 (74.6%) who
468 Maternal carbon monoxide exposure and newborn anthropometry in a Tanzanian pregnant cohort Blair Wylie1, Emmaneul Matechi2, Yahya Kishashu3, Zheng Zhou4, Russ Hauser4, Zul Premji3, Ferdinand Mugusi3, Brent Coull4, Majid Ezzati5, Wafaie Fawzi4 1
Massachusetts General Hopsital, Division of Maternal Fetal Medicine, Vincent Obstetrics and Gynecology Department, Boston, MA, 2African Academy for Public Health, Dar es Salaam, United Republic of Tanzania, 3 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania, 4Harvard School of Public Health, Boston, MA, 5 Imperial College of London School of Public Health, Lond, United Kingdom
OBJECTIVE: To investigate the relationship between personal exposure
to carbon monoxide (CO) during pregnancy and newborn birth weight (BW), length (BL) and head circumference (HC). STUDY DESIGN: Estimates from the Global Disease Burden Study 2010 suggest household air pollution from biomass fuels (wood, charcoal, crop residues) accounts for 3.5 million deaths annually.
S234 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014
Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues
OBJECTIVE: Exposure to inflammation-induced preterm birth (IIPB) is known to lead to long-term neurodevelopmental disabilities in offspring. We have previously demonstrated in a mouse model of IIPB that maternal administration of human adipose-derived mesenchymal stem cells (MSC) modulates the maternal and fetal immune response to intrauterine inflammation and decreases preterm birth rate. The objective of this study was to investigate the effect of MSC on offspring neurodevelopment and to construct possible mechanisms. STUDY DESIGN: A mouse model of IIPB was utilized, with 49 dams in 3 treatment groups: 1) negative control-intrauterine (IU) normal saline (NS); 2) positive control - IU lipopolysaccharide (LPS); and 3) IU LPS + IP MSC, administered 15 h prior to the onset of inflammation. Maternal spleen (MS), placentas and fetal brains were collected. Immunohistochemistry (HuNu, DAPI and CD44) was performed for localization and MSC count. Multiplex ELISA for protein levels of IL-1b, IL6, TNFa, IL12, INFg, IL-2, IL4, IL5 and IL10 was performed. A standardized murine behavioral scoring system (battery of 7 tests) was used to evaluate neurologic outcomes at postnatal days (PND) 5, 9 and 13. Standard statistics were employed. RESULTS: MSC administration improved behavioral phenotype as early as PND5 (p<0.001, ANOVA). MSC localized to placenta at 10x greater concentration than MS. These findings were associated with increase in IL-2 and IL-4 in placenta in the LPS+MSC as compared to LPS group (p<0.05 for both). CONCLUSION: Maternal administration of MSC was associated with improved neurobehavioral development in the group exposed to intrauterine inflammation. We speculate that the adverse effects of intrauterine inflammation were blocked by MSC through immunomodulation in placenta, possibly implicating a role of placental immune response to inflammation in perinatal brain injury.
www.AJOG.org
maintained CL 25 mm. The covariate-adjusted ROC curve had moderate predictive value (AUC ¼ 0.753), but did not identify a discernible cut point. Evaluation of various CL cutoffs demonstrated that a CL 39 mm had the greatest negative predictive value (85.1%). No cut point existed above which there was no CL shortening, although at 39 mm only 2 patients (1.1%) shortened within 2 weeks (p < 0.001) (Figure). CONCLUSION: In high-risk patients whose initial CL is at least 39 mm, CL shortening <25 mm is uncommon in the following 2 weeks. Therefore, patients with CL greater than this threshold may require less frequent CL surveillance.
Kaplan-Meier plot of time to CL shortening or delivery based on initial CL 39mm at first ultrasound (log-rank p<0.001)
Test characteristics of various CL cut points identified in the ROC analysis
467 Frequency of cervical length surveillance in high-risk women based on initial cervical length Akila Subramaniam1, Lorie Harper1, Jeffery Szychowski2, John Owen1 1 University of Alabama at Birmingham, Division of Maternal-Fetal Medicine, Birmingham, AL, 2University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL
OBJECTIVE: Shortened cervical length (CL) assessed by transvaginal ultrasound is a major predictor of spontaneous preterm birth (SPTB), for which effective interventions are available. Since the natural history of CL shortening has not been well-characterized, serial mid-trimester CL assessment is performed in high-risk patients. We sought to estimate the predictive value of the initial CL for subsequent shortening <25 mm. STUDY DESIGN: We conducted a secondary analysis of a multi-center randomized trial of high-risk women (prior SPTB < 34 weeks) with CL screening at least every 2 weeks from 160/7- 226/7 weeks. Our primary outcome was CL <25 mm or delivery prior to a second follow-up CL sonogram. The risk of CL shortening was analyzed by initial CL (at 16-18 weeks). Logistic regression was used to estimate the effect of initial CL on the risk of shortening while adjusting for confounders, and a receiver operator characteristics (ROC) curve was created to identify an ideal threshold value for the absence of later shortening. Kaplan-Meier curves were used to assess the time to CL <25 mm, based on initial CL. RESULTS: 786 high-risk women were identified in the primary RCT197 with CL shortening < 23 weeks (25.0%), 3 with delivery within 2 weeks of initial ultrasound (0.4%), and 586 (74.6%) who
468 Maternal carbon monoxide exposure and newborn anthropometry in a Tanzanian pregnant cohort Blair Wylie1, Emmaneul Matechi2, Yahya Kishashu3, Zheng Zhou4, Russ Hauser4, Zul Premji3, Ferdinand Mugusi3, Brent Coull4, Majid Ezzati5, Wafaie Fawzi4 1
Massachusetts General Hopsital, Division of Maternal Fetal Medicine, Vincent Obstetrics and Gynecology Department, Boston, MA, 2African Academy for Public Health, Dar es Salaam, United Republic of Tanzania, 3 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania, 4Harvard School of Public Health, Boston, MA, 5 Imperial College of London School of Public Health, Lond, United Kingdom
OBJECTIVE: To investigate the relationship between personal exposure
to carbon monoxide (CO) during pregnancy and newborn birth weight (BW), length (BL) and head circumference (HC). STUDY DESIGN: Estimates from the Global Disease Burden Study 2010 suggest household air pollution from biomass fuels (wood, charcoal, crop residues) accounts for 3.5 million deaths annually.
S234 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014