- Email: [email protected]
716: Risk factors for neonatal complications related to placental dysfunction
www.AJOG.org
Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health
716 Risk factors for neonatal complications related to placental dysfunction
Poster Session V
717 Risk factors for maternal placenta-related syndromes Madeline Rice1
Madeline Rice1 1
Maternal-Fetal Medicine Units Network, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
OBJECTIVE: To evaluate whether two neonatal complications that have
been linked to placental dysfunction, small for gestational age (SGA) and preterm birth (PTB), share risk factors, including maternal placenta-related syndromes. STUDY DESIGN: Data were abstracted by trained research staff from maternal and neonatal charts of deliveries occurring on randomly selected days representingone-thirdofdeliveriesacross25UShospitalsoverathree-yearperiod. This analysis was restricted to non-anomalous singleton deliveries (N⫽99,164). Stillbirths, which also have been linked to placental dysfunction,wereexcludedduetotheirrarefrequencyinthiscohort(N⫽30;0.03%). The neonatal outcome categories were defined as: 1) SGA ⬍ 10th percentile and term; 2) PTB ⬍ 37 wks and not SGA; and 3) both SGA and PTB. Odds ratios and 95% CIs were estimated using multivariable multinomial logistic regression. RESULTS: The frequency of outcomes was 7.7% for SGA, 7.6% for PTB and 2.0% for both SGA and PTB. SGA and PTB shared several cardiovascular and obstetric history risk factors (e.g., chronic hypertension [HTN], cigarette use, cocaine use, prior PTB). Increasing body mass index was associated with decreasing odds of both SGA and PTB. Diabetes was associated with an increased odds of PTB, but a decreased odds of SGA. Premature rupture of membranes was a strong risk factor for PTB. With regards to maternal placenta-related syndromes, preeclampsia (PE) and abruption were significantly and strongly associated with PTB. Abruption in the absence of gestational hypertension or PE was not associated with SGA. CONCLUSION: These data support the concept of multiple risk factors, with shared and unshared pathways, leading to SGA and PTB. Our results, based on a large well-characterized cohort, also provide guidance to focus preventive strategies aimed at improving neonatal outcomes. Potentially modifiable risk factors for both SGA and PTB included chronic HTN, cigarette use and cocaine use. PE and abruption were particularly noteworthy risk factors for PTB.
1 Maternal-Fetal Medicine Units Network, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
OBJECTIVE: To evaluate whether maternal outcomes related to a placental etiology share risk factors using a large well-characterized cohort. STUDY DESIGN: Data were abstracted by trained clinical research staff from maternal and neonatal charts of deliveries occurring on computer-generated randomly selected days representing one-third of deliveries across 25 US hospitals over a three-year period. This analysis was restricted to non-anomalous singleton deliveries (N⫽99,164). The maternal outcome categories were defined as: 1) gestational hypertension (GHTN) in the absence of abruption; 2) preeclampsia (PE) in the absence of abruption; 3) abruption in the absence of GHTN or PE; and 4) abruption in the presence of GHTN or PE. Odds ratios and 95% confidence intervals were estimated using multivariable multinomial logistic regression. RESULTS: The frequency of outcomes was 3.4% for GHTN in the absence of abruption,5.7%forPEintheabsenceofabruption,0.8%forabruptioninthe absence of GHTN or PE and 0.1% for abruption in the presence of GHTN or PE.Thematernaloutcomessharedsomecardiovascularandobstetrichistory risk factors (e.g., chronic hypertension, prior preterm birth), but not all (e.g., cigarette use was only associated with abruption; pre-gestational diabetes and nulliparitywereassociatedwithPE,butnotabruption).Increasingbodymass index was associated with increasing odds of GHTN and PE, but decreasing odds of abruption. Premature rupture of membranes was associated with an increased odds of abruption, but a decreased odds of GHTN and PE. CONCLUSION: These data support the concept of multiple risk factors, with shared and unshared pathways, leading to maternal outcomes related to placental dysfunction. Of potentially modifiable risk factors, chronic HTN may play an important role in both abruption and pregnancy-induced hypertensive disorders.
Odds ratios (95%CIs) from the multivariable multinomial logistic regression model for neonatal complications linked to placental dysfunction
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S301
Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health
716 Risk factors for neonatal complications related to placental dysfunction
Poster Session V
717 Risk factors for maternal placenta-related syndromes Madeline Rice1
Madeline Rice1 1
Maternal-Fetal Medicine Units Network, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
OBJECTIVE: To evaluate whether two neonatal complications that have
been linked to placental dysfunction, small for gestational age (SGA) and preterm birth (PTB), share risk factors, including maternal placenta-related syndromes. STUDY DESIGN: Data were abstracted by trained research staff from maternal and neonatal charts of deliveries occurring on randomly selected days representingone-thirdofdeliveriesacross25UShospitalsoverathree-yearperiod. This analysis was restricted to non-anomalous singleton deliveries (N⫽99,164). Stillbirths, which also have been linked to placental dysfunction,wereexcludedduetotheirrarefrequencyinthiscohort(N⫽30;0.03%). The neonatal outcome categories were defined as: 1) SGA ⬍ 10th percentile and term; 2) PTB ⬍ 37 wks and not SGA; and 3) both SGA and PTB. Odds ratios and 95% CIs were estimated using multivariable multinomial logistic regression. RESULTS: The frequency of outcomes was 7.7% for SGA, 7.6% for PTB and 2.0% for both SGA and PTB. SGA and PTB shared several cardiovascular and obstetric history risk factors (e.g., chronic hypertension [HTN], cigarette use, cocaine use, prior PTB). Increasing body mass index was associated with decreasing odds of both SGA and PTB. Diabetes was associated with an increased odds of PTB, but a decreased odds of SGA. Premature rupture of membranes was a strong risk factor for PTB. With regards to maternal placenta-related syndromes, preeclampsia (PE) and abruption were significantly and strongly associated with PTB. Abruption in the absence of gestational hypertension or PE was not associated with SGA. CONCLUSION: These data support the concept of multiple risk factors, with shared and unshared pathways, leading to SGA and PTB. Our results, based on a large well-characterized cohort, also provide guidance to focus preventive strategies aimed at improving neonatal outcomes. Potentially modifiable risk factors for both SGA and PTB included chronic HTN, cigarette use and cocaine use. PE and abruption were particularly noteworthy risk factors for PTB.
1 Maternal-Fetal Medicine Units Network, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
OBJECTIVE: To evaluate whether maternal outcomes related to a placental etiology share risk factors using a large well-characterized cohort. STUDY DESIGN: Data were abstracted by trained clinical research staff from maternal and neonatal charts of deliveries occurring on computer-generated randomly selected days representing one-third of deliveries across 25 US hospitals over a three-year period. This analysis was restricted to non-anomalous singleton deliveries (N⫽99,164). The maternal outcome categories were defined as: 1) gestational hypertension (GHTN) in the absence of abruption; 2) preeclampsia (PE) in the absence of abruption; 3) abruption in the absence of GHTN or PE; and 4) abruption in the presence of GHTN or PE. Odds ratios and 95% confidence intervals were estimated using multivariable multinomial logistic regression. RESULTS: The frequency of outcomes was 3.4% for GHTN in the absence of abruption,5.7%forPEintheabsenceofabruption,0.8%forabruptioninthe absence of GHTN or PE and 0.1% for abruption in the presence of GHTN or PE.Thematernaloutcomessharedsomecardiovascularandobstetrichistory risk factors (e.g., chronic hypertension, prior preterm birth), but not all (e.g., cigarette use was only associated with abruption; pre-gestational diabetes and nulliparitywereassociatedwithPE,butnotabruption).Increasingbodymass index was associated with increasing odds of GHTN and PE, but decreasing odds of abruption. Premature rupture of membranes was associated with an increased odds of abruption, but a decreased odds of GHTN and PE. CONCLUSION: These data support the concept of multiple risk factors, with shared and unshared pathways, leading to maternal outcomes related to placental dysfunction. Of potentially modifiable risk factors, chronic HTN may play an important role in both abruption and pregnancy-induced hypertensive disorders.
Odds ratios (95%CIs) from the multivariable multinomial logistic regression model for neonatal complications linked to placental dysfunction
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S301