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Antiviral suppression to prevent recurrence of herpes simplex virus (HSV) infections in pregnancy: a meta-analysis
S98 SMFM Abstracts
December 2003 Am J Obstet Gynecol
121
SEROPREVALENCE OF BORDETELLA PERTUSSIS ANTIBODIES IN MOTHERS AND THEIR NEWBORN INFANTS BERNARD GONIK1, KAROLINE PUDER1, NATHAN GONIK2, MICHAEL KRUGER1, 1Wayne State University, Ob/Gyn, Detroit, MI 2University of Michigan, School of Public Health, Ann Arbor, MI OBJECTIVE: Pertussis is a highly communicable, vaccine-preventable respiratory disease. The most rapidly increasing incidence in the United States is in adolescents and young adults. Adult family members are the likely major reservoirs that infect susceptible infants prior to completion of childhood vaccination. We studied maternal-neonatal paired blood samples for the presence of pertussis-related antibodies to assess level of immunity and transplacental antibody passage. STUDY DESIGN: Unselected maternal-neonatal cord blood samples were collected from 101 term deliveries in a single urban hospital setting. Sera were analyzed for anti-PT, FHA, and PRN IgG antibodies by ELISA. Antibody titers were calculated using reference line methodology. Antibody values were logtransformed to establish geometric mean titers (GMT) for analysis. Student t-test, Mann-Whitney, Pearson correlation, and chi-square were used for statistical comparisons as appropriate. RESULTS: Mean (SD) maternal age, gestational age, and birth weight were 26.8 (6.8) yrs, 38.9 (1.4) wks, and 3239 (501) gms, respectively. Detectable maternal levels of anti-PT, FHA, and PRN were found in 34.7%, 95.0%, and 80.2% of subjects, respectively. Maternal antibody GMT (SD) for PT, FHA, and PRN were 4.4 (2.6), 26.6 (3.1), and 12.3 (2.9), respectively. There was no significant relationship between anti-PT, FHA, or PRN detection or GMT and maternal age. Maternal anti-PT, FHA, and PRN were highly correlated with neonatal cord blood values. CONCLUSION: A large number of gravidas have low or undetectable pertussis-related antibody levels, suggesting susceptibility to infection. Despite efficient transplacental passage of these antibodies, neonates similarly have limited measurable protection. These data support the need for adolescent or adult vaccination against Bordetella pertussis. Clinicians and their patients should be aware of the risk for infant infection via family member transmission.
123
ELEVATED MIDTRIMESTER MATERNAL SERUM HUMAN CHORIONIC GONADOTROPIN (HCG) LEVELS, BUT NOT PROGESTERONE OR ESTRIOL, ARE ASSOCIATED WITH THE SUBSEQUENT DEVELOPMENT OF PREECLAMPSIA (PRE) PATRICK RAMSEY1, RI2 1 CHARD PARKER , National Institutes of Health, Obstetrics/Gynecology, Bethesda, MD 2University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, AL OBJECTIVE: Abnormal levels of hCG and other endocrine markers have been associated with adverse pregnancy outcomes. We sought to determine whether midtrimester maternal serum levels of hCG, progesterone, and estriol were associated with the subsequent development of PRE. STUDY DESIGN: As an ancillary investigation to a multicenter trial of aspirin therapy in women at high risk for PRE, serum specimens were collected at the initial study visit (11-26 wks). HCG, progesterone, and estriol levels were assessed using commercial immunoassays. Mild and severe PRE were defined using standard definitions. RESULTS: Specimens from 515 non-hypertensive/non-proteinuric women were available for study. The incidence of PRE was 13.2%. Median serum levels of hCG (28,069 vs 23,767 mIU/mL, P = 0.12), progesterone (79 vs 75 ng/mL, P = 0.84), and estriol (2.3 vs 2.4 ng/mL, P = 0.71) were similar between women with and without PRE. Hormone levels were then dichotomized by the 90th %ile cutoff for the study cohort (hCG-58,577 mIU/mL, progesterone-151 ng/mL, estriol-5.6 ng/mL) to evaluate the association of elevated levels with the development of PRE (Table). Elevated hCG levels were associated with both mild PRE (OR 2.6, 95%CI: 1.1-6.5) and severe PRE (OR 3.0, 95% CI: 1.3-7.7). In multivariate analysis, adjusting for gestational age at specimen collection, maternal age, study treatment, race, smoking status, BMI, diabetes, and multifetal gestations, an elevated hCG level remained significantly associated with subsequent PRE. CONCLUSION: In women at risk, elevated midtrimester serum levels of hCG, but not progesterone or estriol, are significantly associated with the subsequent development of PRE.
122
DOWN SYNDROME LIVE BIRTHS IN THE U. S. FROM 1989 TO 2001 JAMES EGAN1, PETER BENN2, CAROLYN ZELOP1, ALAN BOLNICK1, ELISA GIANFERRARI1, ADAM BORGIDA1, 1University of Connecticut, Obstetrics/Gynecology, Farmington, CT 2University of Connecticut, Pediatrics, Farmington, CT OBJECTIVE: To evaluate the influence of newer Down syndrome (DS) screening techniques, we investigated observed to expected DS live births (LB) in the U.S. from 1989 to 2001. STUDY DESIGN: Using National Center for Health Statistics data, we recorded the number of maternal age-specific LB by calendar year from 1989 to 2001 and stratified them into LB to women 15-34 and 35-49 years old. In our model age-specific maternal LB were multiplied by the age-specific DS risk to estimate the number of DS LB from 1989-2001 assuming no terminations (TOP). Maternal age-specific birth certificate reports of DS LB were recorded by year from 1989-2001. We assumed no temporal change in the pattern of birth certificate reporting. We used the observed to expected number of DS LB to women 15-34 in 1989 as our reference. RESULTS: With no TOP, estimated DS LB rates would have increased 32% from 1.39/1000 in 1989 to 1.84/1000 in 2001. The reported LB rate for DS in 1989 was 1.19/1000 and 0.92/1000 in 2001. This difference suggests that 15% of all DS cases had a TOP in 1989. TOP increased to 49% for all cases in 1998 and has plateaued since then. For women 15-34 we assumed no TOP for DS in 1989; by 2001, however, 45.4% had TOP. In women 35 or older, there were 43.2% TOP for DS in 1989 and 53.1% in 2001. Based on our model, the number of DS LB declined 22.4% from 4800 in 1989 to 3725 in 2001. CONCLUSION: Prenatal screening, diagnosis, and intervention have resulted in a significant decline in DS LB in the U.S. from 1989 to 2001 despite an estimated increase in the number of DS pregnancies.
124
ANTIVIRAL SUPPRESSION TO PREVENT RECURRENCE OF HERPES SIMPLEX VIRUS (HSV) INFECTIONS IN PREGNANCY: A META-ANALYSIS PATRICK RAMSEY1, WILLIAM ANDREWS1, 1University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, AL OBJECTIVE: To conduct meta-analysis using available data from randomized clinical trials (RCT) that evaluated the use of antiviral suppressive therapy for HSV in pregnancy. STUDY DESIGN: A systematic literature review was conducted using PUBMED and MEDLINE 1966-2003 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCT were abstracted and meta-analysis was conducted using the Mantel-Haenszel fixed effects model with test of heterogeneity. RESULTS: Nine studies of either acyclovir or valacyclovir therapy for the prevention of HSV in pregnancy were identified. Six of the 9 studies were RCT and were included in the meta-analysis. One of the 6 studies included women with primary HSV, with the remainder with recurrent HSV. Five of the six studies used acyclovir with one using valacyclovir. Study protocols were similar with treatment initiated at 36 wks and continued until delivery. Meta-analysis outcomes are shown in the Table below. No significant heterogeneity was noted between the studies for the outcomes evaluated. CONCLUSION: Use of antiviral therapy in late pregnancy in women with a history of HSV significantly reduces cesarean delivery for active HSV, HSV recurrences after treatment initiation, HSV recurrence at delivery, and HSV shedding at delivery as measured by both culture and PCR.
Change in estimated to reported Down syndrome births in the U.S. from 1989 to 2001.
December 2003 Am J Obstet Gynecol
121
SEROPREVALENCE OF BORDETELLA PERTUSSIS ANTIBODIES IN MOTHERS AND THEIR NEWBORN INFANTS BERNARD GONIK1, KAROLINE PUDER1, NATHAN GONIK2, MICHAEL KRUGER1, 1Wayne State University, Ob/Gyn, Detroit, MI 2University of Michigan, School of Public Health, Ann Arbor, MI OBJECTIVE: Pertussis is a highly communicable, vaccine-preventable respiratory disease. The most rapidly increasing incidence in the United States is in adolescents and young adults. Adult family members are the likely major reservoirs that infect susceptible infants prior to completion of childhood vaccination. We studied maternal-neonatal paired blood samples for the presence of pertussis-related antibodies to assess level of immunity and transplacental antibody passage. STUDY DESIGN: Unselected maternal-neonatal cord blood samples were collected from 101 term deliveries in a single urban hospital setting. Sera were analyzed for anti-PT, FHA, and PRN IgG antibodies by ELISA. Antibody titers were calculated using reference line methodology. Antibody values were logtransformed to establish geometric mean titers (GMT) for analysis. Student t-test, Mann-Whitney, Pearson correlation, and chi-square were used for statistical comparisons as appropriate. RESULTS: Mean (SD) maternal age, gestational age, and birth weight were 26.8 (6.8) yrs, 38.9 (1.4) wks, and 3239 (501) gms, respectively. Detectable maternal levels of anti-PT, FHA, and PRN were found in 34.7%, 95.0%, and 80.2% of subjects, respectively. Maternal antibody GMT (SD) for PT, FHA, and PRN were 4.4 (2.6), 26.6 (3.1), and 12.3 (2.9), respectively. There was no significant relationship between anti-PT, FHA, or PRN detection or GMT and maternal age. Maternal anti-PT, FHA, and PRN were highly correlated with neonatal cord blood values. CONCLUSION: A large number of gravidas have low or undetectable pertussis-related antibody levels, suggesting susceptibility to infection. Despite efficient transplacental passage of these antibodies, neonates similarly have limited measurable protection. These data support the need for adolescent or adult vaccination against Bordetella pertussis. Clinicians and their patients should be aware of the risk for infant infection via family member transmission.
123
ELEVATED MIDTRIMESTER MATERNAL SERUM HUMAN CHORIONIC GONADOTROPIN (HCG) LEVELS, BUT NOT PROGESTERONE OR ESTRIOL, ARE ASSOCIATED WITH THE SUBSEQUENT DEVELOPMENT OF PREECLAMPSIA (PRE) PATRICK RAMSEY1, RI2 1 CHARD PARKER , National Institutes of Health, Obstetrics/Gynecology, Bethesda, MD 2University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, AL OBJECTIVE: Abnormal levels of hCG and other endocrine markers have been associated with adverse pregnancy outcomes. We sought to determine whether midtrimester maternal serum levels of hCG, progesterone, and estriol were associated with the subsequent development of PRE. STUDY DESIGN: As an ancillary investigation to a multicenter trial of aspirin therapy in women at high risk for PRE, serum specimens were collected at the initial study visit (11-26 wks). HCG, progesterone, and estriol levels were assessed using commercial immunoassays. Mild and severe PRE were defined using standard definitions. RESULTS: Specimens from 515 non-hypertensive/non-proteinuric women were available for study. The incidence of PRE was 13.2%. Median serum levels of hCG (28,069 vs 23,767 mIU/mL, P = 0.12), progesterone (79 vs 75 ng/mL, P = 0.84), and estriol (2.3 vs 2.4 ng/mL, P = 0.71) were similar between women with and without PRE. Hormone levels were then dichotomized by the 90th %ile cutoff for the study cohort (hCG-58,577 mIU/mL, progesterone-151 ng/mL, estriol-5.6 ng/mL) to evaluate the association of elevated levels with the development of PRE (Table). Elevated hCG levels were associated with both mild PRE (OR 2.6, 95%CI: 1.1-6.5) and severe PRE (OR 3.0, 95% CI: 1.3-7.7). In multivariate analysis, adjusting for gestational age at specimen collection, maternal age, study treatment, race, smoking status, BMI, diabetes, and multifetal gestations, an elevated hCG level remained significantly associated with subsequent PRE. CONCLUSION: In women at risk, elevated midtrimester serum levels of hCG, but not progesterone or estriol, are significantly associated with the subsequent development of PRE.
122
DOWN SYNDROME LIVE BIRTHS IN THE U. S. FROM 1989 TO 2001 JAMES EGAN1, PETER BENN2, CAROLYN ZELOP1, ALAN BOLNICK1, ELISA GIANFERRARI1, ADAM BORGIDA1, 1University of Connecticut, Obstetrics/Gynecology, Farmington, CT 2University of Connecticut, Pediatrics, Farmington, CT OBJECTIVE: To evaluate the influence of newer Down syndrome (DS) screening techniques, we investigated observed to expected DS live births (LB) in the U.S. from 1989 to 2001. STUDY DESIGN: Using National Center for Health Statistics data, we recorded the number of maternal age-specific LB by calendar year from 1989 to 2001 and stratified them into LB to women 15-34 and 35-49 years old. In our model age-specific maternal LB were multiplied by the age-specific DS risk to estimate the number of DS LB from 1989-2001 assuming no terminations (TOP). Maternal age-specific birth certificate reports of DS LB were recorded by year from 1989-2001. We assumed no temporal change in the pattern of birth certificate reporting. We used the observed to expected number of DS LB to women 15-34 in 1989 as our reference. RESULTS: With no TOP, estimated DS LB rates would have increased 32% from 1.39/1000 in 1989 to 1.84/1000 in 2001. The reported LB rate for DS in 1989 was 1.19/1000 and 0.92/1000 in 2001. This difference suggests that 15% of all DS cases had a TOP in 1989. TOP increased to 49% for all cases in 1998 and has plateaued since then. For women 15-34 we assumed no TOP for DS in 1989; by 2001, however, 45.4% had TOP. In women 35 or older, there were 43.2% TOP for DS in 1989 and 53.1% in 2001. Based on our model, the number of DS LB declined 22.4% from 4800 in 1989 to 3725 in 2001. CONCLUSION: Prenatal screening, diagnosis, and intervention have resulted in a significant decline in DS LB in the U.S. from 1989 to 2001 despite an estimated increase in the number of DS pregnancies.
124
ANTIVIRAL SUPPRESSION TO PREVENT RECURRENCE OF HERPES SIMPLEX VIRUS (HSV) INFECTIONS IN PREGNANCY: A META-ANALYSIS PATRICK RAMSEY1, WILLIAM ANDREWS1, 1University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, AL OBJECTIVE: To conduct meta-analysis using available data from randomized clinical trials (RCT) that evaluated the use of antiviral suppressive therapy for HSV in pregnancy. STUDY DESIGN: A systematic literature review was conducted using PUBMED and MEDLINE 1966-2003 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCT were abstracted and meta-analysis was conducted using the Mantel-Haenszel fixed effects model with test of heterogeneity. RESULTS: Nine studies of either acyclovir or valacyclovir therapy for the prevention of HSV in pregnancy were identified. Six of the 9 studies were RCT and were included in the meta-analysis. One of the 6 studies included women with primary HSV, with the remainder with recurrent HSV. Five of the six studies used acyclovir with one using valacyclovir. Study protocols were similar with treatment initiated at 36 wks and continued until delivery. Meta-analysis outcomes are shown in the Table below. No significant heterogeneity was noted between the studies for the outcomes evaluated. CONCLUSION: Use of antiviral therapy in late pregnancy in women with a history of HSV significantly reduces cesarean delivery for active HSV, HSV recurrences after treatment initiation, HSV recurrence at delivery, and HSV shedding at delivery as measured by both culture and PCR.
Change in estimated to reported Down syndrome births in the U.S. from 1989 to 2001.