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568: Maternal indications and neonatal complications in late preterm birth
www.AJOG.org
Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics
2008 were examined for patterns of pregnancy-associated death in Ohio. STUDY DESIGN: Pregnancy-associated deaths were identified via several methods. Prior to 2007, all deaths classified in the “O” category of ICD-10 were considered pregnancy-related, and the corresponding birth or fetal death record was sought. In addition, a search on each female decedent’s name and birth date was performed for any births or fetal deaths within the past year. Starting in 2007, in addition to the “O” code search methodology, Ohio adopted the 2003 US Standard Death Certificate specifications, including a checkbox permitting the certifier to indicate concurrent pregnancy or gravid state within 12 months of death. The electronic vital record of each identified pregnancy-associated death was merged with the corresponding birth or fetal death record, as appropriate, for analysis. RESULTS: A total of 320 potential pregnancy-associated deaths were identified. After 23 improbable cases were excluded, 297 (93%) remained for analysis. In 2005, the PRMR was 14.5, [Caucasian: 12.6; African American: 23.0] As expected, the adoption of the pregnancy associated mortality death certificate checkbox was associated with a rise in the PRMR from 6.8 in 2006 to 17.0 in 2007. There were no statistically significant changes in the distributions of age, race or marital status of the decedents from 2003-2008. Proportionally more deaths in 2007 and 2008 were coded as pregnancy-related, perhaps due to increased awareness as a result of the pregnancy-associated death checkbox. CONCLUSIONS: The implementation of the 2003 US Death Certificate Standard resulted in an increase in the reporting of pregnancy-associated deaths in Ohio and a change in the coding of those deaths.
567 Effect of maternal age on the risk of stillbirth: a population-based cohort study on 37 million births in the United States Jacques Balayla1, Laurent Azoulay1, Jonathan Assayag1, Haim Abenhaim1 1
Jewish General Hospital, McGill University, Montreal, QC
OBJECTIVE: Increased maternal age has been associated with an in-
creased risk of stillbirth. The objective of our study was to calculate the incidence of stillbirths in the United States and to evaluate the adjusted effect of maternal age on the incidence of stillbirth. STUDY DESIGN: We conducted a population-based cohort study using the CDC’s “Linked Birth-Infant Death” and “Fetal Death” data files during a 10-year period in the United States. Our cohort consisted of all births in the United States from 1995 until 2004. We excluded all births of gestational age under 24 weeks and all births with a reported congenital malformation. We estimated the effect of maternal age on the risk of stillbirth using logistic regression analysis adjusting for ethnicity, plurality, education, and marital status. RESULTS: There were 37,492,760 births during the study period of which 130,353 (3.5/1,000) were stillbirths. As compared to women between the ages of 25-30, decreasing maternal age was associated with the following risk of stillbirth: OR 0.95 (0.93-0.97) for ages 2025, 0.97 (0.94-0.99) for ages 15-20, and 1.32 (1.18 – 1.47) for ages ⬍15. As compared to women between the ages of 25-30, increasing maternal age was associated with an increasing risk of stillbirth: 1.02 (0.99-1.04) for ages 30-35, 1.25 (1.21-1.28) for ages 35-40, 1.67 (1.60-1.75) for ages 40-45, and 2.10 (1.81-2.45) for ages 45⫹. CONCLUSIONS: The risk of stillbirths appears to be lowest among women between the ages of 15 and 35. Although the overall risk is low, it increases considerably in women at the extremes of the reproductive age spectrum. Antenatal surveillance may be justified in these women.
Poster Session IV
568 Maternal indications and neonatal complications in late preterm birth Janelle Walton1, Kristie Dyson1, Jay Iams1 1
The Ohio State University, Columbus, OH
OBJECTIVE: The objective of this study was to evaluate the indications
for late preterm birth (34⫹0 to 36⫹6 weeks) and compare neonatal outcomes by week at a singular tertiary care institution. STUDY DESIGN: A retrospective cohort study was conducted among women who delivered at the University Medical Center between January 1, 2006 and December 31, 2009. Women who delivered a live, non-anomalous singleton fetus between 34 and 36 weeks were included. Maternal medical records were assessed for demographics and delivery indication. Spontaneous was defined as birth after PTL or PROM. Indicated was defined as induction of labor or cesarean section for medical or obstetrical reasons. Neonatal medical records were assessed for outcome data. RESULTS: There were 2084 births between 34⫹0 and 36⫹6 weeks. 759 were excluded for the following reasons: 16 were stillbirths, 97 were anomalous, 222 were multiple gestations, 429 were missing maternal and/or neonatal records, leaving 1325 births for analysis. Of the 1325, 803 were spontaneous (322 PTL and 481 PROM) and 522 were indicated. Of the 522 indicated births, 295 were delivered for hypertensive disorders of pregnancy, 85 for IUGR/oligohydramnios, 59 for maternal disease complications, 47 for vaginal bleeding and 36 for other complications. Medically indicated late preterm neonates were more likely to have Apgar score less than or equal to 7 at 5 minutes when compared to spontaneously born neonates (9.2% vs 3.7%; p⬍.001). There was no statistically significant difference in other neonatal outcomes when comparing spontaneous and indicated late preterm births. Neonatal outcomes by gestational week of delivery (34 vs 35 vs 36) were analyzed. Significant differences are summarized in the table. No difference was detected in the occurrence of cardiovascular problems, intraventricular hemorrhage, sepsis or hypoglycemia in the early neonatal period. CONCLUSIONS: Spontaneous preterm delivery comprises the majority of late preterm births. Gestational age at delivery in weeks is better correlated with neonatal outcome than the indication for late preterm delivery. Neonatal outcome by gestational age, No (%) 34 weeks nⴝ342 Apgar ⬍7 at 5 min
34 (10)
35 weeks nⴝ393 24 (6)
36 weeks nⴝ590 20 (3)
P value .0005
..........................................................................................................................................................................................
NICU admission 156 (46) 131 (33) 146 (25) ⬍.0001 .......................................................................................................................................................................................... Days hospitalized (SD) 7.6 (6.8) 5.9 (5.7) 5.1 (5.5) ⬍.05 .......................................................................................................................................................................................... Respiratory complications
79 (23)
71 (18)
70 (12)
.0002
..........................................................................................................................................................................................
Hyperbilirubinemia 58 (17) 56 (14) 61 (10) .019 .......................................................................................................................................................................................... Feeding difficulty 138 (40) 119 (30) 121 (21) ⬍.001 ..........................................................................................................................................................................................
569 First and third trimester plasma vitamin D, angiogenic factors, and preeclampsia Janet Rich-Edwards1, Jennifer Stuart2, Chloe Zera1, Ellen Seely1, Augusto Litonjua1, Scott Weiss1, Louise Wilkins-Haug1, Thomas McElrath1 1
Brigham and Women’s Hospital, Boston, MA, Harvard School of Public Health, Boston, MA
2
OBJECTIVE: A Pittsburgh study reported an inverse association between maternal plasma 25-hydroxy vitamin D (25(OH)D) and risk of preeclampsia (PE). We sought to replicate that study and test associations of 25(OH)D with angiogenic factors associated with PE in this and other cohorts. STUDY DESIGN: Nested case control study of singleton pregnancies from the prospective Prediction of Preeclampsia cohort in Boston.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S227
Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics
2008 were examined for patterns of pregnancy-associated death in Ohio. STUDY DESIGN: Pregnancy-associated deaths were identified via several methods. Prior to 2007, all deaths classified in the “O” category of ICD-10 were considered pregnancy-related, and the corresponding birth or fetal death record was sought. In addition, a search on each female decedent’s name and birth date was performed for any births or fetal deaths within the past year. Starting in 2007, in addition to the “O” code search methodology, Ohio adopted the 2003 US Standard Death Certificate specifications, including a checkbox permitting the certifier to indicate concurrent pregnancy or gravid state within 12 months of death. The electronic vital record of each identified pregnancy-associated death was merged with the corresponding birth or fetal death record, as appropriate, for analysis. RESULTS: A total of 320 potential pregnancy-associated deaths were identified. After 23 improbable cases were excluded, 297 (93%) remained for analysis. In 2005, the PRMR was 14.5, [Caucasian: 12.6; African American: 23.0] As expected, the adoption of the pregnancy associated mortality death certificate checkbox was associated with a rise in the PRMR from 6.8 in 2006 to 17.0 in 2007. There were no statistically significant changes in the distributions of age, race or marital status of the decedents from 2003-2008. Proportionally more deaths in 2007 and 2008 were coded as pregnancy-related, perhaps due to increased awareness as a result of the pregnancy-associated death checkbox. CONCLUSIONS: The implementation of the 2003 US Death Certificate Standard resulted in an increase in the reporting of pregnancy-associated deaths in Ohio and a change in the coding of those deaths.
567 Effect of maternal age on the risk of stillbirth: a population-based cohort study on 37 million births in the United States Jacques Balayla1, Laurent Azoulay1, Jonathan Assayag1, Haim Abenhaim1 1
Jewish General Hospital, McGill University, Montreal, QC
OBJECTIVE: Increased maternal age has been associated with an in-
creased risk of stillbirth. The objective of our study was to calculate the incidence of stillbirths in the United States and to evaluate the adjusted effect of maternal age on the incidence of stillbirth. STUDY DESIGN: We conducted a population-based cohort study using the CDC’s “Linked Birth-Infant Death” and “Fetal Death” data files during a 10-year period in the United States. Our cohort consisted of all births in the United States from 1995 until 2004. We excluded all births of gestational age under 24 weeks and all births with a reported congenital malformation. We estimated the effect of maternal age on the risk of stillbirth using logistic regression analysis adjusting for ethnicity, plurality, education, and marital status. RESULTS: There were 37,492,760 births during the study period of which 130,353 (3.5/1,000) were stillbirths. As compared to women between the ages of 25-30, decreasing maternal age was associated with the following risk of stillbirth: OR 0.95 (0.93-0.97) for ages 2025, 0.97 (0.94-0.99) for ages 15-20, and 1.32 (1.18 – 1.47) for ages ⬍15. As compared to women between the ages of 25-30, increasing maternal age was associated with an increasing risk of stillbirth: 1.02 (0.99-1.04) for ages 30-35, 1.25 (1.21-1.28) for ages 35-40, 1.67 (1.60-1.75) for ages 40-45, and 2.10 (1.81-2.45) for ages 45⫹. CONCLUSIONS: The risk of stillbirths appears to be lowest among women between the ages of 15 and 35. Although the overall risk is low, it increases considerably in women at the extremes of the reproductive age spectrum. Antenatal surveillance may be justified in these women.
Poster Session IV
568 Maternal indications and neonatal complications in late preterm birth Janelle Walton1, Kristie Dyson1, Jay Iams1 1
The Ohio State University, Columbus, OH
OBJECTIVE: The objective of this study was to evaluate the indications
for late preterm birth (34⫹0 to 36⫹6 weeks) and compare neonatal outcomes by week at a singular tertiary care institution. STUDY DESIGN: A retrospective cohort study was conducted among women who delivered at the University Medical Center between January 1, 2006 and December 31, 2009. Women who delivered a live, non-anomalous singleton fetus between 34 and 36 weeks were included. Maternal medical records were assessed for demographics and delivery indication. Spontaneous was defined as birth after PTL or PROM. Indicated was defined as induction of labor or cesarean section for medical or obstetrical reasons. Neonatal medical records were assessed for outcome data. RESULTS: There were 2084 births between 34⫹0 and 36⫹6 weeks. 759 were excluded for the following reasons: 16 were stillbirths, 97 were anomalous, 222 were multiple gestations, 429 were missing maternal and/or neonatal records, leaving 1325 births for analysis. Of the 1325, 803 were spontaneous (322 PTL and 481 PROM) and 522 were indicated. Of the 522 indicated births, 295 were delivered for hypertensive disorders of pregnancy, 85 for IUGR/oligohydramnios, 59 for maternal disease complications, 47 for vaginal bleeding and 36 for other complications. Medically indicated late preterm neonates were more likely to have Apgar score less than or equal to 7 at 5 minutes when compared to spontaneously born neonates (9.2% vs 3.7%; p⬍.001). There was no statistically significant difference in other neonatal outcomes when comparing spontaneous and indicated late preterm births. Neonatal outcomes by gestational week of delivery (34 vs 35 vs 36) were analyzed. Significant differences are summarized in the table. No difference was detected in the occurrence of cardiovascular problems, intraventricular hemorrhage, sepsis or hypoglycemia in the early neonatal period. CONCLUSIONS: Spontaneous preterm delivery comprises the majority of late preterm births. Gestational age at delivery in weeks is better correlated with neonatal outcome than the indication for late preterm delivery. Neonatal outcome by gestational age, No (%) 34 weeks nⴝ342 Apgar ⬍7 at 5 min
34 (10)
35 weeks nⴝ393 24 (6)
36 weeks nⴝ590 20 (3)
P value .0005
..........................................................................................................................................................................................
NICU admission 156 (46) 131 (33) 146 (25) ⬍.0001 .......................................................................................................................................................................................... Days hospitalized (SD) 7.6 (6.8) 5.9 (5.7) 5.1 (5.5) ⬍.05 .......................................................................................................................................................................................... Respiratory complications
79 (23)
71 (18)
70 (12)
.0002
..........................................................................................................................................................................................
Hyperbilirubinemia 58 (17) 56 (14) 61 (10) .019 .......................................................................................................................................................................................... Feeding difficulty 138 (40) 119 (30) 121 (21) ⬍.001 ..........................................................................................................................................................................................
569 First and third trimester plasma vitamin D, angiogenic factors, and preeclampsia Janet Rich-Edwards1, Jennifer Stuart2, Chloe Zera1, Ellen Seely1, Augusto Litonjua1, Scott Weiss1, Louise Wilkins-Haug1, Thomas McElrath1 1
Brigham and Women’s Hospital, Boston, MA, Harvard School of Public Health, Boston, MA
2
OBJECTIVE: A Pittsburgh study reported an inverse association between maternal plasma 25-hydroxy vitamin D (25(OH)D) and risk of preeclampsia (PE). We sought to replicate that study and test associations of 25(OH)D with angiogenic factors associated with PE in this and other cohorts. STUDY DESIGN: Nested case control study of singleton pregnancies from the prospective Prediction of Preeclampsia cohort in Boston.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S227