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739: Duration of intrapartum antibiotics for Group B streptococcus on the diagnosis of neonatal sepsis
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Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health
738 Pregnancy complications and outcomes in women perinatally infected with human immunodeficiency virus Maria Miraz1, Omar Duenas-Garcia1, Daniella Fonseca1, Priya Prasad1, Maria Timoney1, Rodney Wright2 1
Bronx Lebanon Hospital Center, Obstetrics and Gynecology, Bronx, NY, Montefiore Medical Center/Albert Einstein College of Medicine, Obstetrics & Gynecology and Women’s Health, Bronx, NY 2
OBJECTIVE: To describe the pregnancy outcomes of women with perinatally acquired HIV (PAH) compared to those with non perinatally acquired HIV (NPAH), and to determine if factors such as ethnicity and income affect the pregnancy outcomes in these patients. STUDY DESIGN: We performed a retrospective case control study of HIV infected women who delivered in a large South Bronx NY hospital between January 2005 and December 2011. Cases were PAH patients and NPAH patients served as controls. The Student’s t-test was used for continuous variables and Chi square for categorical variables. Bivariate analyses were performed to determine the associations between birth outcome and pregnancy outcome with factors such as viral load, CD4 count and method of contracting HIV using both linear and logistic regression. RESULTS: 13 pregnancies were identified in the PAH group and 170 NPAH pregnancies. PAH patients were younger (mean age 21) compared to NPAH (mean age 31). 69% of PAH patients were Hispanic compared to 34% of NPAH (p⫽0.02). 23% of PAH and 27% of NPAH had some form of mental health problem (p⫽ns). The median BMI for PAH patients was 26 where the mean BMI for NPAH was 31 (p⫽0.01). 37% of all patients reported some form of domestic or family violence (p⫽ns). Preterm delivery and low birthweight were significantly higher in PAH (p⫽0.001). Median age at delivery for PAH was 35.4 weeks. Only 31% of PAH had an undetectable viral load at delivery compared to 78% of NPAH (p⫽0.001). PAH were 7.8x less likely to have an undetectable viral load at delivery but there were no mother to child HIV transmissions in the PAH group. There were two HIV infected infants born in the NPAH group to mothers with limited prenatal care (p⬍0.001). CONCLUSION: In a very high risk HIV infected patient population, numerous psychosocial factors may play a role in determining birth outcome. Careful attention to all of these factors may be key to eliminating mother to child transmission of HIV and improving birth outcomes.
739 Duration of intrapartum antibiotics for Group B streptococcus on the diagnosis of neonatal sepsis Mark Turrentine1, Anthony Greisinger2, Kimberly Brown2, Oscar Wehmanen2, Melanie Mouzoon3 1 Kelsey Seybold Clinic, Obstetrics & Gynecology, Houston, TX, 2Kelsey Seybold Clinic, Kelsey Research Foundation, Houston, TX, 3Kelsey Seybold Clinic, Pediatrics, Houston, TX
OBJECTIVE: Guidelines for Group B Streptococcus (GBS) identifies asymptomatic infants born to mothers who were colonized with GBS, but received ⬍ 4 hours of intrapartum antibiotics, as at risk for presenting later with sepsis. The origin of this 4-hour duration for GBS intrapartum antibiotic prophylaxis (IAP) is unclear. We assessed if ⬍ 4 hours of maternal IAP for GBS, without other risk factors, increases the incidence of clinical neonatal sepsis. STUDY DESIGN: A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ⱖ 37 weeks gestation who presented in labor from January 1, 2003, through December 31, 2007 was performed. All singleton births at ⱖ 37 weeks gestation were included. Exclusion criteria included scheduled cesarean delivery, or chorioamnionitis. Infants diagnosed with clinical sepsis stratified by duration of maternal IAP received (⬍ or ⱖ 4 hours duration) was determined. RESULTS: Women were divided into groups based on duration of IAP with 1,149 receiving ⬍ 4 hours and 3,633 receiving ⱖ 4 hours. More infants whose mothers received ⬍ 4 hours of IAP (compared to ⱖ 4 hours) were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus
Poster Session V
15 of 3,633 (0.4%), P ⫽ .03. Multivariate logistic regression analysis, including significant maternal intrapartum factors, showed treatment with ⱖ 4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16 to 0.79, P ⫽ .01. The duration of IAP impacted the diagnosis of neonatal clinical sepsis; with the diagnosis decreasing the longer the mother received IAP (Table). CONCLUSION: In asymptomatic at-risk term newborns exposed to ⬍ 4 hours of IAP for GBS, a greater number will be given the discharge diagnosis of clinical sepsis. Further, the duration of IAP impacted the diagnosis of neonatal clinical sepsis; with the diagnosis decreasing the longer the mother received IAP. Infants whose mothers received ⬍ 2 hours of IAP had the greatest risk of being diagnosed with clinical sepsis.
740 Genes, environment, and preterm birth: change in bacterial vaginosis status and inflammatory polymorphisms Molly Stout1, Heather Frey1, Methodius Tuuli1, Alison Cahill1, Anthony Odibo1, Jenifer Allsworth1, George Macones1 1 ashington University in St. Louis, Obstetrics and Gynecology, Saint Louis, MO
OBJECTIVE: Prior studies suggest polymorphisms in inflammatory genes are associated with risk for preterm birth (PTB). Nucleotide polymorphisms (SNPs) in tumor necrosis factor alpha (TNF) were more common in women with PTB. We tested the hypothesis that SNPs in the TNF gene interact with bacterial vaginosis (BV) infection persistence or clearance and mediate the risk for PTB. STUDY DESIGN: A secondary analysis of pregnancies enrolled in a multicenter RCT investigating periodontal disease and PTB. 8 TNF SNPs were identified via dbSNP, Bio-Carta, and KEGG. BV diagnosis (Nugent score) was collected at enrollment (6-20 weeks) and in the third trimester. Change in BV status was defined as “new onset”, “cleared” or “persistent” at the second time point. Due to SNP variability by race this analysis was limited to Black women. Univariable and logistic regression models tested interactions between change in BV status and TNF SNPs in the prediction of preterm birth. RESULTS: Of 620 Black women with complete BV and SNP data, 13% delivered ⬍37 weeks. There was no association between any single TNF SNP status (heterozygote or homozygote rare allele) with BV onset, clearance or persistence. Carriage of any rare TNF allele (hetero or homozygous rare) was not associated with an increased risk for BV persistence (OR⫽1.6, 95% CI 0.6-4.1, p⫽0.31). New onset of BV in the third trimester was not associated with increased risk for PTB compared to never having BV. However, BV at the time of enrollment, whether the infection cleared or was persistent were both associated with a 2-fold increased risk for PTB (Table). There was no evidence of interaction between BV clearance or persistence with TNF SNP status and the risk for PTB.
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S311
Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health
738 Pregnancy complications and outcomes in women perinatally infected with human immunodeficiency virus Maria Miraz1, Omar Duenas-Garcia1, Daniella Fonseca1, Priya Prasad1, Maria Timoney1, Rodney Wright2 1
Bronx Lebanon Hospital Center, Obstetrics and Gynecology, Bronx, NY, Montefiore Medical Center/Albert Einstein College of Medicine, Obstetrics & Gynecology and Women’s Health, Bronx, NY 2
OBJECTIVE: To describe the pregnancy outcomes of women with perinatally acquired HIV (PAH) compared to those with non perinatally acquired HIV (NPAH), and to determine if factors such as ethnicity and income affect the pregnancy outcomes in these patients. STUDY DESIGN: We performed a retrospective case control study of HIV infected women who delivered in a large South Bronx NY hospital between January 2005 and December 2011. Cases were PAH patients and NPAH patients served as controls. The Student’s t-test was used for continuous variables and Chi square for categorical variables. Bivariate analyses were performed to determine the associations between birth outcome and pregnancy outcome with factors such as viral load, CD4 count and method of contracting HIV using both linear and logistic regression. RESULTS: 13 pregnancies were identified in the PAH group and 170 NPAH pregnancies. PAH patients were younger (mean age 21) compared to NPAH (mean age 31). 69% of PAH patients were Hispanic compared to 34% of NPAH (p⫽0.02). 23% of PAH and 27% of NPAH had some form of mental health problem (p⫽ns). The median BMI for PAH patients was 26 where the mean BMI for NPAH was 31 (p⫽0.01). 37% of all patients reported some form of domestic or family violence (p⫽ns). Preterm delivery and low birthweight were significantly higher in PAH (p⫽0.001). Median age at delivery for PAH was 35.4 weeks. Only 31% of PAH had an undetectable viral load at delivery compared to 78% of NPAH (p⫽0.001). PAH were 7.8x less likely to have an undetectable viral load at delivery but there were no mother to child HIV transmissions in the PAH group. There were two HIV infected infants born in the NPAH group to mothers with limited prenatal care (p⬍0.001). CONCLUSION: In a very high risk HIV infected patient population, numerous psychosocial factors may play a role in determining birth outcome. Careful attention to all of these factors may be key to eliminating mother to child transmission of HIV and improving birth outcomes.
739 Duration of intrapartum antibiotics for Group B streptococcus on the diagnosis of neonatal sepsis Mark Turrentine1, Anthony Greisinger2, Kimberly Brown2, Oscar Wehmanen2, Melanie Mouzoon3 1 Kelsey Seybold Clinic, Obstetrics & Gynecology, Houston, TX, 2Kelsey Seybold Clinic, Kelsey Research Foundation, Houston, TX, 3Kelsey Seybold Clinic, Pediatrics, Houston, TX
OBJECTIVE: Guidelines for Group B Streptococcus (GBS) identifies asymptomatic infants born to mothers who were colonized with GBS, but received ⬍ 4 hours of intrapartum antibiotics, as at risk for presenting later with sepsis. The origin of this 4-hour duration for GBS intrapartum antibiotic prophylaxis (IAP) is unclear. We assessed if ⬍ 4 hours of maternal IAP for GBS, without other risk factors, increases the incidence of clinical neonatal sepsis. STUDY DESIGN: A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ⱖ 37 weeks gestation who presented in labor from January 1, 2003, through December 31, 2007 was performed. All singleton births at ⱖ 37 weeks gestation were included. Exclusion criteria included scheduled cesarean delivery, or chorioamnionitis. Infants diagnosed with clinical sepsis stratified by duration of maternal IAP received (⬍ or ⱖ 4 hours duration) was determined. RESULTS: Women were divided into groups based on duration of IAP with 1,149 receiving ⬍ 4 hours and 3,633 receiving ⱖ 4 hours. More infants whose mothers received ⬍ 4 hours of IAP (compared to ⱖ 4 hours) were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus
Poster Session V
15 of 3,633 (0.4%), P ⫽ .03. Multivariate logistic regression analysis, including significant maternal intrapartum factors, showed treatment with ⱖ 4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16 to 0.79, P ⫽ .01. The duration of IAP impacted the diagnosis of neonatal clinical sepsis; with the diagnosis decreasing the longer the mother received IAP (Table). CONCLUSION: In asymptomatic at-risk term newborns exposed to ⬍ 4 hours of IAP for GBS, a greater number will be given the discharge diagnosis of clinical sepsis. Further, the duration of IAP impacted the diagnosis of neonatal clinical sepsis; with the diagnosis decreasing the longer the mother received IAP. Infants whose mothers received ⬍ 2 hours of IAP had the greatest risk of being diagnosed with clinical sepsis.
740 Genes, environment, and preterm birth: change in bacterial vaginosis status and inflammatory polymorphisms Molly Stout1, Heather Frey1, Methodius Tuuli1, Alison Cahill1, Anthony Odibo1, Jenifer Allsworth1, George Macones1 1 ashington University in St. Louis, Obstetrics and Gynecology, Saint Louis, MO
OBJECTIVE: Prior studies suggest polymorphisms in inflammatory genes are associated with risk for preterm birth (PTB). Nucleotide polymorphisms (SNPs) in tumor necrosis factor alpha (TNF) were more common in women with PTB. We tested the hypothesis that SNPs in the TNF gene interact with bacterial vaginosis (BV) infection persistence or clearance and mediate the risk for PTB. STUDY DESIGN: A secondary analysis of pregnancies enrolled in a multicenter RCT investigating periodontal disease and PTB. 8 TNF SNPs were identified via dbSNP, Bio-Carta, and KEGG. BV diagnosis (Nugent score) was collected at enrollment (6-20 weeks) and in the third trimester. Change in BV status was defined as “new onset”, “cleared” or “persistent” at the second time point. Due to SNP variability by race this analysis was limited to Black women. Univariable and logistic regression models tested interactions between change in BV status and TNF SNPs in the prediction of preterm birth. RESULTS: Of 620 Black women with complete BV and SNP data, 13% delivered ⬍37 weeks. There was no association between any single TNF SNP status (heterozygote or homozygote rare allele) with BV onset, clearance or persistence. Carriage of any rare TNF allele (hetero or homozygous rare) was not associated with an increased risk for BV persistence (OR⫽1.6, 95% CI 0.6-4.1, p⫽0.31). New onset of BV in the third trimester was not associated with increased risk for PTB compared to never having BV. However, BV at the time of enrollment, whether the infection cleared or was persistent were both associated with a 2-fold increased risk for PTB (Table). There was no evidence of interaction between BV clearance or persistence with TNF SNP status and the risk for PTB.
Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology
S311