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676: Determinants of alloimmunization to different red cell antigens
SMFM Abstracts 676
www.AJOG.org
DETERMINANTS OF ALLOIMMUNIZATION TO DIFFERENT RED CELL ANTIGENS ALAN TITA1, JOSEPH BIGGIO1, VICTORIA CHAPMAN1, CHERRY NEELY1, JOHN OWEN1, 1University of Alabama at Birmingham, Obstetrics and Gynecology, Birmingham, Alabama OBJECTIVE: We quantified the relationship between maternal characteristics and the prevalence of alloimmunization to different red blood cell (rbc) antigens. STUDY DESIGN: Cross-sectional study using prospectively collected data in our obstetric database for women receiving prenatal care and giving birth (ⱖ20 weeks gestation) from 1991-2006. Prevalence of allo-immunization to Rh-D, Kell, and any important rbc antigen, as well as attainment of our institutional critical titer of 1:16 (1:8 for Kell) were compared by potential determinants of allo-immunization. Logistic regression with generalized estimating equations to account for confounding and correlation between pregnancies or births from the same woman was used. RESULTS: Of 59,346 gravidas, 177 pregnancies were sensitized to at least one clinically important rbc antigen, and 85 (48%) attained a critical titer. Factors consistently associated with allo-immunization types are presented (Table). Black race was protective for allo-immunization to D or any antigen as well as for attaining a critical titer. In the presence of sensitization to Kell or any antigen, a prior history of blood transfusion is more likely. History of drug abuse was not a significant determinant of any type of allo-immunization.
Risk factors Black race Parity (continuous) Maternal age (continuous) Rh Negative status Self-reported history of blood transfusion Hemoglobinopathy**
Anti-D (n⫽72)
Anti-Kell (n⫽37)
0.26* 1.42* 1.01
1.28 1.03 1.11*
36.3* 1.37 53.3*
Any Antigen (n⫽177)
2.55 43.8* 5.13*
Attained critical Titer (n⫽85)
0.52* 1.24* 1.07*
0.22* 1.28* 1.06*
6.16* 8.48*
7.84* 4.02*
16.8*
678
31.8*
*Confidence interval excludes 1, ** SS, SC or S/B-thalassemia hemoglobinopathies for which a blood transfusion is likely.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.706
CONCLUSION: Although several factors contribute to the development of rbc alloimmunization the greatest risk appears to be associated with blood transfusion while black race is a strong protective factor except for Kell. 679
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.704
677
ANTIDEPRESSANT USE IN PREGNANCY AND NEONATAL OUTCOMES EVA CARIGNAN1, ADAM BORGIDA2, JAMES EGAN3, VICTOR HERSON4, ROMA BHUTA2, DEBORAH FELDMAN5, 1University of Connecticut School of Medicine, Obstetrics and Gynecology, Farmington, Connecticut, 2Hartford Hospital, Obstetrics and Gynecology, Hartford, Connecticut, 3Society for Maternal-Fetal Medicine, Farmington, Connecticut, 4Connecticut Children’s Medical Center, Neonatology, Hartford, Connecticut, 5Hartford Hospital, Ob-Gyn, Hartford, Connecticut OBJECTIVE: To review short-term neonatal outcomes in pregnancies exposed to antidepressants. STUDY DESIGN: We reviewed all singleton births between January 2004 through December 2005 in our computerized perinatal and neonatal databases from our tertiary care, urban hospital. Neonatal outcomes from mothers who reported antidepressant use during pregnancy were compared to unexposed pregnancies. Medical records were reviewed to ascertain the type of antidepressant used and SSRI use was compared to other antidepressants used. RESULTS: There were 4,227 singleton births, of which 645 (15.3%) reported antidepressant use (SSRIs 8.2% and other anti-depressants 7.1%). Mothers reporting SSRI use were more likely to be older, multiparous and deliver at an earlier gestational age. Neonatal outcomes were very similar for the groups (table). CONCLUSION: Antidepressant use during pregnancy is common for women who suffer from depression and anxiety. We found few significant differences in neonatal outcomes when comparing antidepressant use, including SSRIs, to unexposed pregnancies.
Outcome
SSRI
Other antidepress.
None
p
N Maternal age (mean) Multiparas (%) Birth weight (mean) ⬍ 2500 gm. (%) 5 min Apgar ⬍7 (%) NICU admit (%) PPHN (%) RDS (%) Feeding intol. (%) NICU stay (mean days) Neonatal deaths (%)
347 30.1 64.0 3263 7.5 3.5 10 0.0 1.2 2.0 11.2 0.58
298 28.7 62.3 3358 6.9 2.0 6 0.0 1.0 0.7 9.1 0.0
3582 29.4 57.1 3314 7.1 1.5 7 0.31 1.4 1.4 17.1 0.4
0.018 0.013 NS NS 0.01 NS NS NS NS NS NS
PRETERM DELIVERY IS ASSOCIATED WITH FUTURE DIABETES INDEPENDENT OF PREECLAMPSIA OR GESTATIONAL DIABETES DARCY CARR1, KATHERINE NEWTON2, JANE HITTI1, THOMAS EASTERLING1, KRISTINA UTZSCHNEIDER3, MIRJAM FAULENBACH3, STEVEN KAHN3, SUSAN HECKBERT1, 1University of Washington, Seattle, Washington, 2 Group Health Center for Health Studies, , Washington, 3VA Puget Sound Health Care System, Seattle, Washington OBJECTIVE: Women with a history of preterm delivery (PTD) have evidence of systemic inflammation and a greater prevalence of cardiovascular disease later in life. Based on the known relationships between inflammation, cardiovascular disease and type 2 diabetes (T2D), we hypothesized that women with prior PTD have a higher risk of developing T2D independent of preeclampsia and gestational diabetes mellitus (GDM). STUDY DESIGN: A retrospective cohort study was performed among 31,611 women who delivered a singleton pregnancy between 1985 and 2002 at Group Health in Washington state and had received care 1 year before delivery. PTD ⬍37 weeks= gestation and preeclampsia were determined by ICD-9 codes. GDM was diagnosed by oral glucose tolerance test. Cox proportional hazard models were used to evaluate the risk of T2D ascertained through 2005 using inpatient and outpatient ICD-9 codes for T2D, pharmacy data for insulin and oral agents, and laboratory data (two occasions of fasting plasma glucose 126 or nonfasting glucose 200 mg/dl). RESULTS: Women with PTD (5,233) and without PTD (26,378) were of similar age at delivery (mean⫾SD: 30.1⫾6.4 vs. 30.1⫾6.2 years) and were followed for a median of 8 years. Women with PTD were more likely to be primigravidas (31.4 vs. 19.8%; P⬍0.001), and to have preeclampsia (9.4 vs. 6.2%; P⬍0.001) or GDM (5.2 vs. 4.3%; P⫽0.003). The incidence rate of T2D was greater in women with PTD (0.8 vs. 0.6/100,000 person-years; P⫽0.02). The hazard ratio (HR) for T2D was higher in women with PTD adjusting for age, primigravida status, preeclampsia and GDM (adj. HR 1.40; 95%CI 1.07-1.82) or after excluding 2,130 women with preeclampsia (adj. HR 1.38; 95%CI 1.04-1.84), 1,376 women with GDM (adj. HR 1.58; 95%CI 1.18-2.12), or both preeclampsia or GDM (adj. HR 1.49; 95%CI 1.08-2.05). CONCLUSION: Women with a history of PTD have a higher risk of developing type 2 diabetes independent of preeclampsia and GDM, suggesting that they have underlying risk factors for metabolic and cardiovascular complications.
VITAMIN D DEFICIENCY IS COMMON IN PREGNANCY DONNA JOHNSON1, CAROL WAGNER1, MYLA EBELING1, THOMAS HULSEY1, BRUCE HOLLIS1, 1Medical University of South Carolina, Charleston, South Carolina OBJECTIVE: The Third National Health and Nutrition Examination Survey (NHANES III) revealed that hypovitaminosis D is a serious public health issue in women of reproductive age. The objective of this study was to determine incidence of hypovitaminosis D in African American, Hispanic and Caucasian pregnant women in Charleston, South Carolina. STUDY DESIGN: After informed consent, blood samples were taken from pregnant females at less than 12 weeks of gestation who did not have diabetes, chronic hypertension, uncontrolled thyroid disease or parathyroid disease. Samples were collected from 117 African Americans, 195 Hispanics, and 145 Caucasians. 25 hydroxyvitamin D (25 (OH)D) levels were measured using a radioimmunoassay (RIA). Serum levels less than 20 ng/ml of 25(OH)D was considered deficient and less than 32 ng/ml of 25(OH)D was consider marginally deficient. Results are reported as means and standard deviation. RESULTS: Mean 25 (OH)D levels in African Americans, Hispanics and Caucasians were 17.7 .⫾ 9.1, 27.9 .⫾ 10.5 and 32.2 .⫾ 9.7, respectively. Seventy-five percent of African Americans, 32% of Hispanics and 11% of Caucasians were deficient. Ninety-six percent of African Americans, 81% of Hispanics and 67% of Caucasians were at least marginally deficient. Overall, 36% of pregnant women were deficient and 80% of pregnant women in this population were frankly or marginally deficient. CONCLUSION: This study clearly demonstrates widespread Vitamin D deficiency in pregnant females, even those living at a southern latitude. (Supported by NIH/NICHD 5R01HD043921) 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.707
*NS ⫽ not significant 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.705
S194
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2007
www.AJOG.org
DETERMINANTS OF ALLOIMMUNIZATION TO DIFFERENT RED CELL ANTIGENS ALAN TITA1, JOSEPH BIGGIO1, VICTORIA CHAPMAN1, CHERRY NEELY1, JOHN OWEN1, 1University of Alabama at Birmingham, Obstetrics and Gynecology, Birmingham, Alabama OBJECTIVE: We quantified the relationship between maternal characteristics and the prevalence of alloimmunization to different red blood cell (rbc) antigens. STUDY DESIGN: Cross-sectional study using prospectively collected data in our obstetric database for women receiving prenatal care and giving birth (ⱖ20 weeks gestation) from 1991-2006. Prevalence of allo-immunization to Rh-D, Kell, and any important rbc antigen, as well as attainment of our institutional critical titer of 1:16 (1:8 for Kell) were compared by potential determinants of allo-immunization. Logistic regression with generalized estimating equations to account for confounding and correlation between pregnancies or births from the same woman was used. RESULTS: Of 59,346 gravidas, 177 pregnancies were sensitized to at least one clinically important rbc antigen, and 85 (48%) attained a critical titer. Factors consistently associated with allo-immunization types are presented (Table). Black race was protective for allo-immunization to D or any antigen as well as for attaining a critical titer. In the presence of sensitization to Kell or any antigen, a prior history of blood transfusion is more likely. History of drug abuse was not a significant determinant of any type of allo-immunization.
Risk factors Black race Parity (continuous) Maternal age (continuous) Rh Negative status Self-reported history of blood transfusion Hemoglobinopathy**
Anti-D (n⫽72)
Anti-Kell (n⫽37)
0.26* 1.42* 1.01
1.28 1.03 1.11*
36.3* 1.37 53.3*
Any Antigen (n⫽177)
2.55 43.8* 5.13*
Attained critical Titer (n⫽85)
0.52* 1.24* 1.07*
0.22* 1.28* 1.06*
6.16* 8.48*
7.84* 4.02*
16.8*
678
31.8*
*Confidence interval excludes 1, ** SS, SC or S/B-thalassemia hemoglobinopathies for which a blood transfusion is likely.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.706
CONCLUSION: Although several factors contribute to the development of rbc alloimmunization the greatest risk appears to be associated with blood transfusion while black race is a strong protective factor except for Kell. 679
0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.704
677
ANTIDEPRESSANT USE IN PREGNANCY AND NEONATAL OUTCOMES EVA CARIGNAN1, ADAM BORGIDA2, JAMES EGAN3, VICTOR HERSON4, ROMA BHUTA2, DEBORAH FELDMAN5, 1University of Connecticut School of Medicine, Obstetrics and Gynecology, Farmington, Connecticut, 2Hartford Hospital, Obstetrics and Gynecology, Hartford, Connecticut, 3Society for Maternal-Fetal Medicine, Farmington, Connecticut, 4Connecticut Children’s Medical Center, Neonatology, Hartford, Connecticut, 5Hartford Hospital, Ob-Gyn, Hartford, Connecticut OBJECTIVE: To review short-term neonatal outcomes in pregnancies exposed to antidepressants. STUDY DESIGN: We reviewed all singleton births between January 2004 through December 2005 in our computerized perinatal and neonatal databases from our tertiary care, urban hospital. Neonatal outcomes from mothers who reported antidepressant use during pregnancy were compared to unexposed pregnancies. Medical records were reviewed to ascertain the type of antidepressant used and SSRI use was compared to other antidepressants used. RESULTS: There were 4,227 singleton births, of which 645 (15.3%) reported antidepressant use (SSRIs 8.2% and other anti-depressants 7.1%). Mothers reporting SSRI use were more likely to be older, multiparous and deliver at an earlier gestational age. Neonatal outcomes were very similar for the groups (table). CONCLUSION: Antidepressant use during pregnancy is common for women who suffer from depression and anxiety. We found few significant differences in neonatal outcomes when comparing antidepressant use, including SSRIs, to unexposed pregnancies.
Outcome
SSRI
Other antidepress.
None
p
N Maternal age (mean) Multiparas (%) Birth weight (mean) ⬍ 2500 gm. (%) 5 min Apgar ⬍7 (%) NICU admit (%) PPHN (%) RDS (%) Feeding intol. (%) NICU stay (mean days) Neonatal deaths (%)
347 30.1 64.0 3263 7.5 3.5 10 0.0 1.2 2.0 11.2 0.58
298 28.7 62.3 3358 6.9 2.0 6 0.0 1.0 0.7 9.1 0.0
3582 29.4 57.1 3314 7.1 1.5 7 0.31 1.4 1.4 17.1 0.4
0.018 0.013 NS NS 0.01 NS NS NS NS NS NS
PRETERM DELIVERY IS ASSOCIATED WITH FUTURE DIABETES INDEPENDENT OF PREECLAMPSIA OR GESTATIONAL DIABETES DARCY CARR1, KATHERINE NEWTON2, JANE HITTI1, THOMAS EASTERLING1, KRISTINA UTZSCHNEIDER3, MIRJAM FAULENBACH3, STEVEN KAHN3, SUSAN HECKBERT1, 1University of Washington, Seattle, Washington, 2 Group Health Center for Health Studies, , Washington, 3VA Puget Sound Health Care System, Seattle, Washington OBJECTIVE: Women with a history of preterm delivery (PTD) have evidence of systemic inflammation and a greater prevalence of cardiovascular disease later in life. Based on the known relationships between inflammation, cardiovascular disease and type 2 diabetes (T2D), we hypothesized that women with prior PTD have a higher risk of developing T2D independent of preeclampsia and gestational diabetes mellitus (GDM). STUDY DESIGN: A retrospective cohort study was performed among 31,611 women who delivered a singleton pregnancy between 1985 and 2002 at Group Health in Washington state and had received care 1 year before delivery. PTD ⬍37 weeks= gestation and preeclampsia were determined by ICD-9 codes. GDM was diagnosed by oral glucose tolerance test. Cox proportional hazard models were used to evaluate the risk of T2D ascertained through 2005 using inpatient and outpatient ICD-9 codes for T2D, pharmacy data for insulin and oral agents, and laboratory data (two occasions of fasting plasma glucose 126 or nonfasting glucose 200 mg/dl). RESULTS: Women with PTD (5,233) and without PTD (26,378) were of similar age at delivery (mean⫾SD: 30.1⫾6.4 vs. 30.1⫾6.2 years) and were followed for a median of 8 years. Women with PTD were more likely to be primigravidas (31.4 vs. 19.8%; P⬍0.001), and to have preeclampsia (9.4 vs. 6.2%; P⬍0.001) or GDM (5.2 vs. 4.3%; P⫽0.003). The incidence rate of T2D was greater in women with PTD (0.8 vs. 0.6/100,000 person-years; P⫽0.02). The hazard ratio (HR) for T2D was higher in women with PTD adjusting for age, primigravida status, preeclampsia and GDM (adj. HR 1.40; 95%CI 1.07-1.82) or after excluding 2,130 women with preeclampsia (adj. HR 1.38; 95%CI 1.04-1.84), 1,376 women with GDM (adj. HR 1.58; 95%CI 1.18-2.12), or both preeclampsia or GDM (adj. HR 1.49; 95%CI 1.08-2.05). CONCLUSION: Women with a history of PTD have a higher risk of developing type 2 diabetes independent of preeclampsia and GDM, suggesting that they have underlying risk factors for metabolic and cardiovascular complications.
VITAMIN D DEFICIENCY IS COMMON IN PREGNANCY DONNA JOHNSON1, CAROL WAGNER1, MYLA EBELING1, THOMAS HULSEY1, BRUCE HOLLIS1, 1Medical University of South Carolina, Charleston, South Carolina OBJECTIVE: The Third National Health and Nutrition Examination Survey (NHANES III) revealed that hypovitaminosis D is a serious public health issue in women of reproductive age. The objective of this study was to determine incidence of hypovitaminosis D in African American, Hispanic and Caucasian pregnant women in Charleston, South Carolina. STUDY DESIGN: After informed consent, blood samples were taken from pregnant females at less than 12 weeks of gestation who did not have diabetes, chronic hypertension, uncontrolled thyroid disease or parathyroid disease. Samples were collected from 117 African Americans, 195 Hispanics, and 145 Caucasians. 25 hydroxyvitamin D (25 (OH)D) levels were measured using a radioimmunoassay (RIA). Serum levels less than 20 ng/ml of 25(OH)D was considered deficient and less than 32 ng/ml of 25(OH)D was consider marginally deficient. Results are reported as means and standard deviation. RESULTS: Mean 25 (OH)D levels in African Americans, Hispanics and Caucasians were 17.7 .⫾ 9.1, 27.9 .⫾ 10.5 and 32.2 .⫾ 9.7, respectively. Seventy-five percent of African Americans, 32% of Hispanics and 11% of Caucasians were deficient. Ninety-six percent of African Americans, 81% of Hispanics and 67% of Caucasians were at least marginally deficient. Overall, 36% of pregnant women were deficient and 80% of pregnant women in this population were frankly or marginally deficient. CONCLUSION: This study clearly demonstrates widespread Vitamin D deficiency in pregnant females, even those living at a southern latitude. (Supported by NIH/NICHD 5R01HD043921) 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.707
*NS ⫽ not significant 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.705
S194
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2007