621: African American babies weigh less at birth because of decreased lean and not fat mass

SMFM Abstracts

www.AJOG.org 621

AFRICAN AMERICAN BABIES WEIGH LESS AT BIRTH BECAUSE OF DECREASED LEAN AND NOT FAT MASS KATHERINE SINGH1, LARRAINE HUSTON PRESLEY1, SAEID AMINI2, PATRICK CATALANO1, 1Case Western Reserve University, Cleveland, Ohio, 2Case Western Reserve University, Reproductive Biology, Cleveland, OH OBJECTIVE: African Amercian women have increased BMI, as compared with, gender and age matched adolescents and adult women in the general population. Our purpose was to determine if African American babies have increased adiposity at birth although they have lower birth weights. STUDY DESIGN: A cohort of 104 African American and 274 Caucasion term, singleton, healthy pregnancies were identified. Women with pre-gestational or gestational diabetes were excluded. The neonates were analyzed using anthropometric measurements within a mean of 1.3 days of life (SD ⫹ 0.90 days). RESULTS: There were no significant differences in demographic characteristics including parity (p⫽0.218), smoking (p⫽0.368), family history of diabetes (p⫽0.546), paternal BMI (0.679), gestational age at delivery (p⫽0.642) or gender (p⫽0.535). In African Americans infants, there were lower birth weights (3.198 ⫹ 0.465 versus 3.364 ⫹ 0.486 kg, p⫽0.003) and decreased lean body mass (2806 ⫹ 0.324 versus 2945 ⫹ 0.330 g, p⫽0.0003), but no differences in fat mass (392 ⫹ 161 versus 417 ⫹ 173 g, p⫽0.193) or percent body fat (11.86 ⫹ 3.42 versus 11.99 ⫹ 3.48 %, p⫽0.750). Because there were significant differences in maternal age (29.5 versus 25.8 years, p ⬍0.001), pre-pregnancy BMI (26.2 versus 30.9 kg/m2, p⬍0.001), and weight gain during pregnancy (15.2 versus 13.4 kg, p⫽0.028) in Caucasion versus African American women, respectively, we adjusted for these factors. After adjustment, infants of the African American women still had significantly lower birth weights (p⫽.003) and lean body mass (p⫽0.002), but again, no differences in fat mass (p⫽0.071) or percent body fat (p⫽0.250). CONCLUSION: Decreased birth weight in African American newborns is due to lower lean body mass and not fat mass. Since fetal lean body mass reflects genetic contributions to fetal growth rather than the in utero environment, we speculate that these differences in lean body mass may be genetic in origin. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.651

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PRENATAL PHENOTYPE AND NEONATAL PRESENTATION OF CARDIO-FACIOCUTANEOUS SYNDROME SUSAN TRAN1, KATHERINE RAUEN2, 1University of California, San Francisco, Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, California, 2University of California, San Francisco, Pediatrics, San Francisco, California OBJECTIVE: To delineate the prenatal phenotype and neonatal characteristics of cardio-facio-cutaneous syndrome (CFC). STUDY DESIGN: From January 2007 to June 2008, a survey was conducted via CFC International. Data was collected on CFC mutation type, maternal characteristics, pregnancy, delivery, and neonatal outcomes, with medical record review performed when available. Summary statistics were calculated using Microsoft Excel. RESULTS: We identified 30 individuals with diagnostic mutations in BRAF (n⫽27), MEK1 (n⫽1), or MEK2 (n⫽2) genes. The median age of participants was 8.5 years. Hyperemesis gravidarum, gestational hypertension, preeclampsia, and gestational diabetes occurred in 17%, 7%, 10%, and 13% of pregnancies, respectively. Prenatal testing included: 0/3 abnormal first trimester nuchal translucency ultrasounds; 0/12 abnormal amnio or CVS karyotype studies; and abnormal second trimester maternal serum triple marker screening in 50% of respondents. Decreased fetal movement was reported in 29%. Various second trimester ultrasound abnormalities were reported (Table). Delivery occurred via spontaneous vaginal, operative vaginal, or cesarean delivery in 28%, 24%, and 48%, respectively, and at a median gestational age of 37.0 weeks with median birth weight of 3515 gm. Neonatal complications included feeding tube requirement (59%), irregular heart beat (28%), and hypoglycemia (14%). CONCLUSION: CFC is a multiple congenital anomaly disorder characterized by craniofacial dysmorphia, ectodermal abnormalities, congenital heart defects, and developmental and growth delay. In mutation-positive individuals, the prenatal phenotype includes polyhydramnios, renal and cardiac abnormalities, macrocephaly, and macrosomia on second and third trimester ultrasound. Elevated rates of operative delivery and neonatal complications were also noted.

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EVIDENCE OF ADRENAL GLAND FETAL ZONE ACTIVATION – A NEW 2D ULTRASOUND METHOD FOR PREDICTION OF PRETERM LABOR (PTL) OZHAN TURAN1, SIFA TURAN1, EDMUND FUNAI2, IRINA A. BUHIMSCHI2, JOSHUA COPEL2, CHRISTOPHER HARMAN1, CATALIN S. BUHIMSCHI2, AHMET BASCHAT1, 1University of Maryland, Baltimore, Department of OB/GYN and Reproductive Sciences, Baltimore, Maryland, 2Yale University, Department of Obstetrics and Gynecology, New Haven, Connecticut OBJECTIVE: To identify correlation between fetal zone enlargement in the adrenal gland (AG) and preterm labor (PTL). STUDY DESIGN: 2D whole-gland (Length (L), Width (W), Depth (D)) and fetal zone (FZ) (l, w, d) measurements were obtained from stored 3D ultrasound blocks in women with singleton pregnancy presenting with PTL at 23-37 weeks. The FZ is readily differentiated from remaining AG tissue by distinct hyperechogenicity. Ratios of l/L, w/W and d/D were calculated. Time interval between ultrasound examination and delivery ⬍7 days defined true PTL. The ratios were correlated with the time interval to delivery using parametric tests and logistic regression analysis after analysis of variance. RESULTS: The dimensions of AG and FZ were measured in 96 pregnancies. There was a significant correlation between interval to delivery and l/L, w/W and d/D ratios (r⫽⫺0.31, p⬍0.0001; r⫽⫺0. 50 p⬍0.0001; r⫽⫺0.52, p⬍0.0001 respectively). Although the size of AG and FZ changed with gestational age (p⬍0.05 for all), the ratios remained constant across the 23-37 week range (p⬎0.05 for all). The interval between ultrasound examination and delivery was ⬍7 days in 34 (Group A) and ⬎7 days in 62 (Group B). FZ was significantly thicker in Group B (p⬍0.0001 for all dimensions) (Figure 1). Logistic regression analysis shows d/D ratio is the main predictor for preterm delivery within 7 days ( r2⫽0.44, p⬍0.0001). ROC curve analysis (Figure 2) shows d/D ratio⬎0.49 was 88% (72.5-96.6) sensitive and 85% (74.2-93.1) specific for prediction of PTL (OR: 39 (11.25-135.2), p⬍0.0001).

CONCLUSION: Simple 2D measurement of the depth of fetal adrenal gland and fetal zone can identify pregnancies complicated with true preterm labor. This new technique allows validation of the relationships between adrenal gland enlargement and preterm labor in a large population, and will in turn allow more precise application of tocolysis, research methodology and preparation for preterm delivery. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.654

Rates of ultrasound findings in CFC syndrome Ultrasound finding

n (%)

Polyhydramnios Renal abnormality Macrocephaly Heart abnormality Macrosomia Other abnormalities

15/29 (52%) 8/28 (29%) 6/27 (22%) 5/27 (19%) 5/28 (18%) 4/26 (15%)

0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.652

Supplement to DECEMBER 2008 American Journal of Obstetrics & Gynecology

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