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919: Driving factors of preterm birth risk in adolescents
Poster Session V
ajog.org
RESULTS: After informed consent, 40 pregnant women (FDA approved only 40) were enrolled. Table 1 shows baseline characteristics and maternal and neonatal outcomes during study period and 6 months after delivery. There were no reportable adverse events. Lactobacilli was detected in the vaginal swab in only 3 subjects (1 in lactobacilli and 2 in placebo group). After 60 days of intervention, there was no difference in BV Blue test, Amsel or Nugent’s score in the 2 groups. All subjects showed good compliance and no significant side effects were noted. CONCLUSION: Administration of oral probiotics during early - mid gestation is safe but showed no effect on vaginal flora (BV Blue test, Nugent’s & Amsel score). Local administration (vaginal) of probiotics may be required to improve vaginal health by changing vaginal microbiota.
CONCLUSION: The increased risk for PTB in adolescents is driven
predominantly by an increased risk for spontaneous PTB subtype. This unique group of young patients may frequently be excluded from the use of S PTB prophylaxis such as 17OHP caproate if they are nulliparous but may have other modifiable factors such as BMI and adequate weight gain.
Table 1 Characteristics of study population (Mean +SD) Characteristic
Lactobacilli group (n=20) Placebo group (n=20) p value
Gestation at entry (in weeks)
12.7+ 3.1
11.8+3.3
NS
Gestation at delivery (in weeks)
38.3+1.8
38+2.9
NS
Douching in last 4 months prior to study
0.05+0.23
0.09+0.30
NS
Number of sex partners 4 months prior to study 1.5+0.57
1.1+0.41
NS
Compliance (scale of 1 to 4)
3.10+1.02
3.09+1.05
NS
Nugent's score prior to study
4.3+0.3
4.1+0.42
NS
Nugent's score score at the end of study
4.3+0.7
3.9+0.9
NS
BV Blue score prior to study
0.2+0.32
0.2+0.35
NS
BV Blue score at the end of study
0.21+0.46
0.10+0.35
NS
Amsel score prior to study
2.0+1.25
2.2+1.48
NS
Amsel score at the end of study
2.1+1.32
2.4+1.26
NS
Treatment for BV during study period
0.1
0+0.23
NS
919 Driving factors of preterm birth risk in adolescents Marta J. Perez, Jen Jen Chang, Lorene A. Temming, Ebony B. Carter, Methodius G. Tuuli, George A. Macones, Molly J. Stout Washington University in St. Louis, Saint Louis, MO
OBJECTIVE: Multiple studies demonstrate that adolescents have an increased risk for adverse obstetric outcomes including preterm birth (PTB). Whether the PTB risk is driven by spontaneous type (S) or medically indicated (I) preterm births is unknown but is important for clinical counseling and surveillance. STUDY DESIGN: This is a population based retrospective cohort study of women who delivered a non-anomalous, singleton first birth between 20-42 weeks from 2012 United States natality data. Incidence of all PTB (<37 weeks) were compared in young adolescents (<16 years), older adolescents (16.0-19.9 years), and adults ( 20 years). S PTB and I PTB were categorized with clinical data in birth certificates using the algorithm by Klebanoff et al. Proportions of S and I PTB subtypes were compared in young adolescents, older adolescents, and adults. Multinomial logistic regression models were used to compare risk factors for S PTB to determine if risk factors are similar in adolescents as adult women. RESULTS: The risk of PTB was increased in adolescents and the highest risk occurred in young adolescents < 16 years of age. The increased risk for PTB is driven by an increased risk for the S PTB subtype with (Table 1). The risk for S PTB increases significantly as maternal age decreases with the youngest group of adolescents at the highest risk for S PTB. Examination of risk factors for S PTB reveals that underweight BMI and less than recommended weight gain during pregnancy are significantly associated with S PTB in adolescents. The risk factors of black race and tobacco use are associated with S PTB in older adolescents and adults but are not important risk factors in the youngest group of adolescent patients (Table 2).
920 Outcomes of pregnancies achieved by double gamete donation: a comparison with donor oocyte pregnancies Lise Preaubert1, Aurelie Vincent1, Pietro Santulli2,3, Vanessa Gayet2, Francois Goffinet1,3, Camille Le Ray1,3 1
Port Royal Maternity, DHU Risks and Pregnancy, Paris, France, 2Department of Gynecology and Reproductive Medicine, Cochin Hospital, Paris, France, 3 Paris Descartes University, Paris, France
OBJECTIVE: Women increasingly resort to ART with donor oocyte
IVF to achieve pregnancy. Oocyte donation is associated with an increased risk of obstetric complications, especially gestational hypertension and preeclampsia. However, scarce data are available on the outcomes of pregnancies achieved by double donation (both oocyte and sperm donation). We wonder whether pregnancies achieved by double donation have an increased risk of obstetric and perinatal complications in comparison with donor oocyte IVF. STUDY DESIGN: Single center cohort study, including all women aged 43 and more having had oocyte donation and giving birth between January 2010 and March 2016. We compared outcomes including gestational hypertension, preeclampsia, gestational diabetes, placental abnormalities, postpartum hemorrhage, perinatal death and preterm delivery between IVF with double donation and donor oocyte IVF, using univariate and multivariate analysis. RESULTS: 247 patients, among whom 53 IVF with double donation and 194 IVF with donor oocyte, gave birth to 339 children. Among IVF with double donation pregnancies, 37.7% were multiple versus 40.2% among IVF with donor oocyte pregnancies (p¼0.75). We observed no significant difference between groups regarding all the obstetric and perinatal complications, except for the risk of gestational diabetes, which was more frequent in IVF with double
S524 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
ajog.org
RESULTS: After informed consent, 40 pregnant women (FDA approved only 40) were enrolled. Table 1 shows baseline characteristics and maternal and neonatal outcomes during study period and 6 months after delivery. There were no reportable adverse events. Lactobacilli was detected in the vaginal swab in only 3 subjects (1 in lactobacilli and 2 in placebo group). After 60 days of intervention, there was no difference in BV Blue test, Amsel or Nugent’s score in the 2 groups. All subjects showed good compliance and no significant side effects were noted. CONCLUSION: Administration of oral probiotics during early - mid gestation is safe but showed no effect on vaginal flora (BV Blue test, Nugent’s & Amsel score). Local administration (vaginal) of probiotics may be required to improve vaginal health by changing vaginal microbiota.
CONCLUSION: The increased risk for PTB in adolescents is driven
predominantly by an increased risk for spontaneous PTB subtype. This unique group of young patients may frequently be excluded from the use of S PTB prophylaxis such as 17OHP caproate if they are nulliparous but may have other modifiable factors such as BMI and adequate weight gain.
Table 1 Characteristics of study population (Mean +SD) Characteristic
Lactobacilli group (n=20) Placebo group (n=20) p value
Gestation at entry (in weeks)
12.7+ 3.1
11.8+3.3
NS
Gestation at delivery (in weeks)
38.3+1.8
38+2.9
NS
Douching in last 4 months prior to study
0.05+0.23
0.09+0.30
NS
Number of sex partners 4 months prior to study 1.5+0.57
1.1+0.41
NS
Compliance (scale of 1 to 4)
3.10+1.02
3.09+1.05
NS
Nugent's score prior to study
4.3+0.3
4.1+0.42
NS
Nugent's score score at the end of study
4.3+0.7
3.9+0.9
NS
BV Blue score prior to study
0.2+0.32
0.2+0.35
NS
BV Blue score at the end of study
0.21+0.46
0.10+0.35
NS
Amsel score prior to study
2.0+1.25
2.2+1.48
NS
Amsel score at the end of study
2.1+1.32
2.4+1.26
NS
Treatment for BV during study period
0.1
0+0.23
NS
919 Driving factors of preterm birth risk in adolescents Marta J. Perez, Jen Jen Chang, Lorene A. Temming, Ebony B. Carter, Methodius G. Tuuli, George A. Macones, Molly J. Stout Washington University in St. Louis, Saint Louis, MO
OBJECTIVE: Multiple studies demonstrate that adolescents have an increased risk for adverse obstetric outcomes including preterm birth (PTB). Whether the PTB risk is driven by spontaneous type (S) or medically indicated (I) preterm births is unknown but is important for clinical counseling and surveillance. STUDY DESIGN: This is a population based retrospective cohort study of women who delivered a non-anomalous, singleton first birth between 20-42 weeks from 2012 United States natality data. Incidence of all PTB (<37 weeks) were compared in young adolescents (<16 years), older adolescents (16.0-19.9 years), and adults ( 20 years). S PTB and I PTB were categorized with clinical data in birth certificates using the algorithm by Klebanoff et al. Proportions of S and I PTB subtypes were compared in young adolescents, older adolescents, and adults. Multinomial logistic regression models were used to compare risk factors for S PTB to determine if risk factors are similar in adolescents as adult women. RESULTS: The risk of PTB was increased in adolescents and the highest risk occurred in young adolescents < 16 years of age. The increased risk for PTB is driven by an increased risk for the S PTB subtype with (Table 1). The risk for S PTB increases significantly as maternal age decreases with the youngest group of adolescents at the highest risk for S PTB. Examination of risk factors for S PTB reveals that underweight BMI and less than recommended weight gain during pregnancy are significantly associated with S PTB in adolescents. The risk factors of black race and tobacco use are associated with S PTB in older adolescents and adults but are not important risk factors in the youngest group of adolescent patients (Table 2).
920 Outcomes of pregnancies achieved by double gamete donation: a comparison with donor oocyte pregnancies Lise Preaubert1, Aurelie Vincent1, Pietro Santulli2,3, Vanessa Gayet2, Francois Goffinet1,3, Camille Le Ray1,3 1
Port Royal Maternity, DHU Risks and Pregnancy, Paris, France, 2Department of Gynecology and Reproductive Medicine, Cochin Hospital, Paris, France, 3 Paris Descartes University, Paris, France
OBJECTIVE: Women increasingly resort to ART with donor oocyte
IVF to achieve pregnancy. Oocyte donation is associated with an increased risk of obstetric complications, especially gestational hypertension and preeclampsia. However, scarce data are available on the outcomes of pregnancies achieved by double donation (both oocyte and sperm donation). We wonder whether pregnancies achieved by double donation have an increased risk of obstetric and perinatal complications in comparison with donor oocyte IVF. STUDY DESIGN: Single center cohort study, including all women aged 43 and more having had oocyte donation and giving birth between January 2010 and March 2016. We compared outcomes including gestational hypertension, preeclampsia, gestational diabetes, placental abnormalities, postpartum hemorrhage, perinatal death and preterm delivery between IVF with double donation and donor oocyte IVF, using univariate and multivariate analysis. RESULTS: 247 patients, among whom 53 IVF with double donation and 194 IVF with donor oocyte, gave birth to 339 children. Among IVF with double donation pregnancies, 37.7% were multiple versus 40.2% among IVF with donor oocyte pregnancies (p¼0.75). We observed no significant difference between groups regarding all the obstetric and perinatal complications, except for the risk of gestational diabetes, which was more frequent in IVF with double
S524 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017