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575: Poor maternal weight gain during pregnancy: does race matter?
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Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics
tation length in a pregnant Boston population, 75% of which has vitamin D insufficiency (⬍30 ng/ml). Raising 25(OH)D levels into an optimal range (⬎40 ng/ml) may allow for further testing of the hypothesis.
Poster Session IV
Table: Median costs and outcomes related to hypertensive disease in pregnancy: 25%-75% median percentiles Neonatal costs No HTN
$1,029-2,640
Maternal costs
Neonatal LOS
$5,078-11,077 1-4 days
GA at delivery 38-40 wks
..........................................................................................................................................................................................
573 A 25 year analysis of perinatal mortality following placental abruption
Gestational HTN $1,266 3,005 $4,820-12,719 2-7 days 38-39 wks .......................................................................................................................................................................................... Mild Preeclampsia $1,498-2,979 $8,645-14,720 2-10 days 37-39 wks ..........................................................................................................................................................................................
Obafemi Ogunlewe1, Jennifer Walsh2, Rebecca Moore1, Rhona Mahony2, Michael Foley2
Severe $2,016-40,921 $10,475-22,835 3-24 days 34-39 wks Preeclampsia ..........................................................................................................................................................................................
1
National Maternity Hospital, Dublin, 2UCD School of Medicine and Medical Science, Dublin
OBJECTIVE: To determine the incidence and perinatal mortality rate
(PNMR) following placental abruption over a 25 year period in a large Irish tertiary referral centre. STUDY DESIGN: Retrospective analysis of all cases of perinatal mortality in our institution over 25 years (1984 - 2008). Trends in overall perinatal mortality were derived and compared to trends in mortality attributed to placental abruption. Statistical analysis was performed using SPSS version 15.0 and chi- square trends were employed to compare perinatal mortality rates over time. RESULTS: The incidence of placental abruption was unchanged over the study period ranging from 0.2 to 0.6/1000 deliveries. Of 2062 perinatal mortality among 186,055 births ⬎ 500g, the perinatal mortality rate (PNMR) was 11.08. Correcting for congenital anomalies, the perinatal mortality rate was 7.4. There were 197/2062 (9.5%) perinatal deaths following placental abruption of whom 185/197 (93%) were stillbirths and 12/197 (7%) were neonatal deaths. There was a significant downward trend in both overall perinatal mortality (p⬍ 0.001) and stillbirths following abruption (p⬍0.001) but no significant difference was identified in the incidence of neonatal deaths following placental abruption. CONCLUSIONS: Although the overall incidence of placental abruption did not change during the 25 years studied, the overall PNMR declined significantly. However the incidence of neonatal death following abruption did not appear to change.
574 Median costs and outcomes related to hypertensive disease in pregnancy Jillian Main1, Teresa Sparks2, Yvonne Cheng3, Aaron B. Caughey4 1 Kaiser, San Francisco, San Francisco, CA, 2Brigham and Women’s Hospital, Boston, MA, 3UCSF, San Francisco, CA, 4Oregon Health & Science University, Portland, OR
OBJECTIVE: To examine the median costs and length of stay associated with hypertensive diseases in pregnancy. STUDY DESIGN: Retrospective cohort study of normal pregnancies and pregnancies complicated by gestational hypertension (gHTN), preeclampsia (PreE) (N⫽ 629,704). Primary data analyzed were the maternal and neonatal cost of hospital care and length of stay (LOS). Median values were compared using the Kruskal-Wallis test. RESULTS: The median cost of neonatal care differs significantly between neonates who are born from normotensive, gHTN, and mild PreE mothers, with a trend of increased costs seen in neonates born from severe PreE mothers. The maternal analysis shows similar costs between gHTN and normotensives, but a significant increase in the cost trend with both mild and severe preeclampsia. The neonatal LOS shows a significant trend of increased LOS with increased acuity of disease. CONCLUSIONS: Both neonatal and maternal cost of care increase with severity of hypertensive disease in pregnancy, most markedly between mild and severe preeclampsia. The neonatal length of stay is increased as acuity of hypertensive disease increases. The burden of disease is so large that even small reductions in rates of preeclampsia would lead to large cost savings for the health system as well as improved neonatal outcomes.
p-value .001 .001 .001 .001 ..........................................................................................................................................................................................
575 Poor maternal weight gain during pregnancy: does race matter? Joel Larma1, Cynthia Shelhaas1 1 The Ohio State University, Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Columbus, OH
OBJECTIVE: Numerous obstetric morbidities are increased in the setting of poor maternal weight gain during pregnancy including poor fetal growth. The objective is to assess racial disparities in the outcome of poor maternal weight gain during pregnancy. STUDY DESIGN: NHANES links national birth certificate data with the health and nutrition status of citizens. The NHANES database was utilized for this analysis. Poor weight gain was defined as a weight gain during pregnancy of less than 15 pounds. Variables were compared between non-Hispanic whites and non-Hispanic blacks. Continuous variables were collapsed into categorical variables. Categorical variables were initially compared using the chi-square test or Fisher’s exact test when appropriate. A p value of ⬍ 0.05 was considered statistically significant. A multiple logistic regression analysis was performed adjusting for variables found to be significant in univariate analysis. All analyses were performed using STATA 11.0. RESULTS: Poor weight gain occurred in 7.4 % of all non-Hispanic whites and for 13.6% of all non-Hispanic blacks (p ⬍ 0.001). The results of the univariate analysis revealed the following variables to be significantly associated with poor weight gain: education, marital status, parity, interpregnancy interval, adequacy of care, smoking, household size, poverty index, GA and metropolitan status. Composite maternal medical problems, age and alcohol use were not significantly associated with poor weight gain. The unadjusted OR for the likelihood of poor weight gain in blacks referent to whites was 1.95 (95% CI of 1.46, 2.61) with p ⬍ 0.001. The aOR for the likelihood of poor weight gain in blacks referent to whites was 1.62 (95% CI of 1.12, 2.34) with p ⬍ 0.05. CONCLUSIONS: Non-Hispanic blacks are significantly more likely to have poor weight gain during pregnancy. The results are significant after multiple logistic regression analysis to control for potential confounding variables. aOR (95% CI) Black
1.65 (1.11, 2.45)
..........................................................................................................................................................................................
Rural Place of Delivery 1.57 (1.04, 2.36) .......................................................................................................................................................................................... Low Education 1.02 (0.79, 1.31) .......................................................................................................................................................................................... Single Marital Status 1.22 (0.8, 1.85) .......................................................................................................................................................................................... Poor Adequacy of Care 1.40 (0.83, 2.36) .......................................................................................................................................................................................... High Parity 1.69 (0.76, 3.77) .......................................................................................................................................................................................... Short Interpregnancy Interval 1.03 (0.62, 1.72) .......................................................................................................................................................................................... Tobacco use 0.9 (0.29, 2.8) .......................................................................................................................................................................................... Large Household size 0.52 (0.1, 2.67) .......................................................................................................................................................................................... High Poverty Income Ratio 1.04 (0.68, 1.58) .......................................................................................................................................................................................... Early Gestational Age at Delivery 1.64 (1.03, 2.62) ..........................................................................................................................................................................................
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S229
Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics
tation length in a pregnant Boston population, 75% of which has vitamin D insufficiency (⬍30 ng/ml). Raising 25(OH)D levels into an optimal range (⬎40 ng/ml) may allow for further testing of the hypothesis.
Poster Session IV
Table: Median costs and outcomes related to hypertensive disease in pregnancy: 25%-75% median percentiles Neonatal costs No HTN
$1,029-2,640
Maternal costs
Neonatal LOS
$5,078-11,077 1-4 days
GA at delivery 38-40 wks
..........................................................................................................................................................................................
573 A 25 year analysis of perinatal mortality following placental abruption
Gestational HTN $1,266 3,005 $4,820-12,719 2-7 days 38-39 wks .......................................................................................................................................................................................... Mild Preeclampsia $1,498-2,979 $8,645-14,720 2-10 days 37-39 wks ..........................................................................................................................................................................................
Obafemi Ogunlewe1, Jennifer Walsh2, Rebecca Moore1, Rhona Mahony2, Michael Foley2
Severe $2,016-40,921 $10,475-22,835 3-24 days 34-39 wks Preeclampsia ..........................................................................................................................................................................................
1
National Maternity Hospital, Dublin, 2UCD School of Medicine and Medical Science, Dublin
OBJECTIVE: To determine the incidence and perinatal mortality rate
(PNMR) following placental abruption over a 25 year period in a large Irish tertiary referral centre. STUDY DESIGN: Retrospective analysis of all cases of perinatal mortality in our institution over 25 years (1984 - 2008). Trends in overall perinatal mortality were derived and compared to trends in mortality attributed to placental abruption. Statistical analysis was performed using SPSS version 15.0 and chi- square trends were employed to compare perinatal mortality rates over time. RESULTS: The incidence of placental abruption was unchanged over the study period ranging from 0.2 to 0.6/1000 deliveries. Of 2062 perinatal mortality among 186,055 births ⬎ 500g, the perinatal mortality rate (PNMR) was 11.08. Correcting for congenital anomalies, the perinatal mortality rate was 7.4. There were 197/2062 (9.5%) perinatal deaths following placental abruption of whom 185/197 (93%) were stillbirths and 12/197 (7%) were neonatal deaths. There was a significant downward trend in both overall perinatal mortality (p⬍ 0.001) and stillbirths following abruption (p⬍0.001) but no significant difference was identified in the incidence of neonatal deaths following placental abruption. CONCLUSIONS: Although the overall incidence of placental abruption did not change during the 25 years studied, the overall PNMR declined significantly. However the incidence of neonatal death following abruption did not appear to change.
574 Median costs and outcomes related to hypertensive disease in pregnancy Jillian Main1, Teresa Sparks2, Yvonne Cheng3, Aaron B. Caughey4 1 Kaiser, San Francisco, San Francisco, CA, 2Brigham and Women’s Hospital, Boston, MA, 3UCSF, San Francisco, CA, 4Oregon Health & Science University, Portland, OR
OBJECTIVE: To examine the median costs and length of stay associated with hypertensive diseases in pregnancy. STUDY DESIGN: Retrospective cohort study of normal pregnancies and pregnancies complicated by gestational hypertension (gHTN), preeclampsia (PreE) (N⫽ 629,704). Primary data analyzed were the maternal and neonatal cost of hospital care and length of stay (LOS). Median values were compared using the Kruskal-Wallis test. RESULTS: The median cost of neonatal care differs significantly between neonates who are born from normotensive, gHTN, and mild PreE mothers, with a trend of increased costs seen in neonates born from severe PreE mothers. The maternal analysis shows similar costs between gHTN and normotensives, but a significant increase in the cost trend with both mild and severe preeclampsia. The neonatal LOS shows a significant trend of increased LOS with increased acuity of disease. CONCLUSIONS: Both neonatal and maternal cost of care increase with severity of hypertensive disease in pregnancy, most markedly between mild and severe preeclampsia. The neonatal length of stay is increased as acuity of hypertensive disease increases. The burden of disease is so large that even small reductions in rates of preeclampsia would lead to large cost savings for the health system as well as improved neonatal outcomes.
p-value .001 .001 .001 .001 ..........................................................................................................................................................................................
575 Poor maternal weight gain during pregnancy: does race matter? Joel Larma1, Cynthia Shelhaas1 1 The Ohio State University, Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Columbus, OH
OBJECTIVE: Numerous obstetric morbidities are increased in the setting of poor maternal weight gain during pregnancy including poor fetal growth. The objective is to assess racial disparities in the outcome of poor maternal weight gain during pregnancy. STUDY DESIGN: NHANES links national birth certificate data with the health and nutrition status of citizens. The NHANES database was utilized for this analysis. Poor weight gain was defined as a weight gain during pregnancy of less than 15 pounds. Variables were compared between non-Hispanic whites and non-Hispanic blacks. Continuous variables were collapsed into categorical variables. Categorical variables were initially compared using the chi-square test or Fisher’s exact test when appropriate. A p value of ⬍ 0.05 was considered statistically significant. A multiple logistic regression analysis was performed adjusting for variables found to be significant in univariate analysis. All analyses were performed using STATA 11.0. RESULTS: Poor weight gain occurred in 7.4 % of all non-Hispanic whites and for 13.6% of all non-Hispanic blacks (p ⬍ 0.001). The results of the univariate analysis revealed the following variables to be significantly associated with poor weight gain: education, marital status, parity, interpregnancy interval, adequacy of care, smoking, household size, poverty index, GA and metropolitan status. Composite maternal medical problems, age and alcohol use were not significantly associated with poor weight gain. The unadjusted OR for the likelihood of poor weight gain in blacks referent to whites was 1.95 (95% CI of 1.46, 2.61) with p ⬍ 0.001. The aOR for the likelihood of poor weight gain in blacks referent to whites was 1.62 (95% CI of 1.12, 2.34) with p ⬍ 0.05. CONCLUSIONS: Non-Hispanic blacks are significantly more likely to have poor weight gain during pregnancy. The results are significant after multiple logistic regression analysis to control for potential confounding variables. aOR (95% CI) Black
1.65 (1.11, 2.45)
..........................................................................................................................................................................................
Rural Place of Delivery 1.57 (1.04, 2.36) .......................................................................................................................................................................................... Low Education 1.02 (0.79, 1.31) .......................................................................................................................................................................................... Single Marital Status 1.22 (0.8, 1.85) .......................................................................................................................................................................................... Poor Adequacy of Care 1.40 (0.83, 2.36) .......................................................................................................................................................................................... High Parity 1.69 (0.76, 3.77) .......................................................................................................................................................................................... Short Interpregnancy Interval 1.03 (0.62, 1.72) .......................................................................................................................................................................................... Tobacco use 0.9 (0.29, 2.8) .......................................................................................................................................................................................... Large Household size 0.52 (0.1, 2.67) .......................................................................................................................................................................................... High Poverty Income Ratio 1.04 (0.68, 1.58) .......................................................................................................................................................................................... Early Gestational Age at Delivery 1.64 (1.03, 2.62) ..........................................................................................................................................................................................
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S229