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Birthweight, gestational age, and perinatal mortality and morbidity in triplets, quadruplets, and quintuplets
SMFM Abstracts S159
Volume 189, Number 6 Am J Obstet Gynecol 356
BIRTHWEIGHT, GESTATIONAL AGE, AND PERINATAL MORTALITY AND MORBIDITY IN TRIPLETS, QUADRUPLETS, AND QUINTUPLETS REBECCA GIBSON1, SHI WU WEN2, HONGZHUAN TAN2, KAREN FUNG KEE FUNG3, MARK WALKER3, 1University of Ottawa, Ottawa, Ontario, Canada 2University of Ottawa, Obstetrics & Gynecology, Ottawa, Ontario, Canada 3University of Ottawa, Maternal-Fetal Medicine, Ottawa, Ontario, Canada OBJECTIVE: High-order multiple gestations have an elevated risk of infants being born small, early in gestation, and with complications. The aim of this study was to describe the increase in low birthweight, early gestational age, and increased perinatal mortality & morbidity with increasing fetal number. STUDY DESIGN: We did a population-based cohort study of 1995-1997 multiple births in the U.S. Analysis was restricted to triplets, quadruplets, & quintuplets born between 24 and 38 weeks’ gestation. Rates of fetal death and congenital anomalies were calculated among total births. Means of gestational age and birthweight, birthweight by gestational age, rates of neonatal death, seizure, mechanical ventilation were calculated among live births. RESULTS: Gestational age at birth was predicted by fetal number, with higher numbers of fetuses having a decreased length of gestation. Mean gestational ages of triplets, quads, & quints were 32.1, 30.4, & 28.8 weeks, respectively. Birthweights per gestational age also decreased with increasing fetal number (Figure 1). Perinatal mortality rates varied by plurality, with triplet, quad, & quint rates calculated to be 9.6%, 12.1%, & 29.3%. Rates of fetal death, neonatal death, congenital anomaly, seizure, mechanical ventilation were 2.9%, 6.9%, 2.7%, 0.1%, & 15.8%, respectively, for triplets; 4.4%, 8.0%, 3.0%, 0.1%, & 21.7% for quads; and 8.8%, 22.5%, 1.0%, 0%, & 19.8% for quints.
358
CAN WE IDENTIFY WOMEN AT INCREASED RISK OF NOT SEEKING HELP FOLLOWING DOMESTIC ABUSE? RICHARD BENOIT1, 1Women & Infants’ Hospital, Providence, RI OBJECTIVE: To identify correlates of women experiencing domestic abuse who do not seek any form of help. This can lead to serious consequences, particularly in pregnancy, where correlates of battering are similar to those outside of pregnancy. STUDY DESIGN: The public access data set of the Chicago Women’s Health Risk Survey was obtained. Women receiving care at four clinical sites in urban Chicago were surveyed. 497 reporting abuse (30% pregnant) were asked about help-seeking (formal and informal) within the previous year. Univariate and bivariate analyses were performed. A dependent variable of interest, helpseek, was created to describe the types of help sought. Multivariate logistic regression and an ROC modeled the outcome helpseek, predicting probability of an abused women not seeking any help. RESULTS: 70% of the women were African American. 18% had not sought any help following abuse (helpseek = 0). Bivariate analyses revealed variables correlated with an increased odds of not seeking help included having children (OR 2.3, 95% CI 1.13-4.6), power score < 25th percentile (OR 2.86, 95% CI 1.65), harassment score < 25th percentile (OR 2.4, 95%CI 1.4-4.2), social support scale < 25th percentile (OR 2, 95%CI 1.19-3.36), partner having abused drugs (OR 2, 95%CI 1.2-3.4), and reported race black (OR 1.96, 95% CI 1.2-3.14). Multivariate logistic regression for the outcome helpseek = 0 revealed that the probability of being in the group of abused woman who did not seek help was increased with unemployment, a partner abusing drugs, low power and control scores, and low social support score. The ROC revealed that a probability of 0.5 as a positive screen had a sensitivity of 16%, specificity of 99%, and LR of 10.7 to predict not seeking help following abuse. CONCLUSION: Identifying correlates of women experiencing domestic abuse who do not seek help may improve screening and offers the potential for developing interventions to empower women to deal with their abuser effectively, and to seek timely assistance.
359
HOW USEFUL IS FIRST-TRIMESTER INCREASED NUCHAL TRANSLUCENCY AS A SCREENING TOOL FOR THE DETECTION OF CONGENITAL HEART DISEASE? RICHARD BENOIT1, 1Women & Infants’ Hospital, Providence, RI OBJECTIVE: To describe the diagnostic accuracy and utility of increased nuchal translucency (NT) thickness in the detection of congenital heart disease (CHD) with a meta-analysis. STUDY DESIGN: Selection criteria included population-based cohort studies, retrospective & prospective, describing the use of fetal nuchal translucency thickness between 10 and 14 weeks’ gestation for first-trimester screening. Antenatal and postnatal outcomes must have been assessed, particularly karyotype and prevalence of congenital heart anomalies. Studies included reported the outcome of a chromsomal normal cohort with respect to nuchal translucency thickness between 10 and 14 weeks’ gestation, allowing determination of relative risk, sensitivity, specificity, likelihood ratio, and risk difference for an abnormal test and congenital heart malformation (with 95% CI). The prevalence of CHD in the population screened was described as high or low. RESULTS: Five cohort studies met inclusion criteria (4 prospective, 1 retrospective). All five assessed a low-risk population, confirmed by prevalence range of 1.7 to 3.3 per 1000. Among three of the studies reporting a NT $2.5 mm as a cutoff for abnormal screen, sensitivity for the detection of congenital heart anomaly among chromosomally normal live births ranged from 15%-27%; specificity, 97%-99%, and likelihood ratio from 4.4 to 18.5. Among the two reporting NT $95th percentile with respect to crown-rump length norms, sensitivity ranged from 36%-56%; specificity, 94%-97%; and likelihood ratio, positive 9 to 10.8. For the three studies reporting NT $99th percentile or $3.5 mm, sensitivity ranged from 12%-40%; specificity, 99%; and likelihood ratio, positive 14.8 to 39. The risk difference for a NT $99% was 4%-6%. CONCLUSION: Nuchal translucency (NT) measurement between 10 and 14 weeks’ gestation is a useful screening tool in the low-risk population for the detection of congenital heart disease, warranting referral for fetal echocardiography.
Figure 1. Birthweight by gestational age for live births (grams vs weeks) CONCLUSION: Birthweight, length of gestation, and risk of mortality & morbidity in multiples are incrementally related to fetal number. Infants of multiple gestation should be evaluated using plurality-specific standards rather than singleton references.
357
MATERNAL DEPRESSIVE SYMPTOMATOLOGY AND PRETERM BIRTH ( < 35 WEEKS’ GESTATION) AMONG LOW-INCOME WOMEN KELLY MCCOLLUM1, ESTHER CHUNG2, JENNIFER CULHANE1, 1Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA 2 Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA OBJECTIVE: To assess the association between maternal depressive symptomatology and preterm birth. STUDY DESIGN: Women were enrolled at their first prenatal visit (mean GA ± SE: 13.7 ± 0.1 weeks) at public clinics in Philadelphia. Demographic, behavioral, and psychosocial data were obtained by interview. Participant data were linked to birth records to obtain gestational age at birth and other control variables. Maternal depressive symptomatology was measured by the Center for Epidemiologic Studies for Depression Scale (CES-D). Participants were classified into one of three groups based on their CES-D score: not depressed (ND; < 16), possibly depressed (PD;$16 and < 22), and probably depressed (PRD;$22). Preterm birth (PTB) was defined as a live birth of less than 35 weeks’ gestation. Participants were excluded if they had preeclampsia, chronic or pregnancy-related hypertension, diabetes, or renal disease. Multiple logistic regression was used to obtain the relative risk of delivering preterm among the depression groups and to control for confounders. RESULTS: A total of 1988 women were included in this analysis. The majority of participants were single (74%), U.S.-born (77%), low-income women (median yearly income: $5798) who did not have an education beyond high school (82%). About half were primiparous. Twenty-three percent were classified as PRD, 16% as PD, and 61% as ND. The incidence of PTB was 5.5%. After controlling for sociodemographic, biomedical, and behavioral characteristics, there was no statistically significant association between maternal depression and PTB: (1) PD vs ND: RR (95%CI): 0.93 (0.62-1.39), (2) PRD vs ND: RR (95%CI): 1.08 (0.77, 1.51). CONCLUSION: Maternal depressive symptomatology is not associated with an increased or decreased risk of preterm birth ( <35 weeks’ gestation) in lowincome, urban women.
Volume 189, Number 6 Am J Obstet Gynecol 356
BIRTHWEIGHT, GESTATIONAL AGE, AND PERINATAL MORTALITY AND MORBIDITY IN TRIPLETS, QUADRUPLETS, AND QUINTUPLETS REBECCA GIBSON1, SHI WU WEN2, HONGZHUAN TAN2, KAREN FUNG KEE FUNG3, MARK WALKER3, 1University of Ottawa, Ottawa, Ontario, Canada 2University of Ottawa, Obstetrics & Gynecology, Ottawa, Ontario, Canada 3University of Ottawa, Maternal-Fetal Medicine, Ottawa, Ontario, Canada OBJECTIVE: High-order multiple gestations have an elevated risk of infants being born small, early in gestation, and with complications. The aim of this study was to describe the increase in low birthweight, early gestational age, and increased perinatal mortality & morbidity with increasing fetal number. STUDY DESIGN: We did a population-based cohort study of 1995-1997 multiple births in the U.S. Analysis was restricted to triplets, quadruplets, & quintuplets born between 24 and 38 weeks’ gestation. Rates of fetal death and congenital anomalies were calculated among total births. Means of gestational age and birthweight, birthweight by gestational age, rates of neonatal death, seizure, mechanical ventilation were calculated among live births. RESULTS: Gestational age at birth was predicted by fetal number, with higher numbers of fetuses having a decreased length of gestation. Mean gestational ages of triplets, quads, & quints were 32.1, 30.4, & 28.8 weeks, respectively. Birthweights per gestational age also decreased with increasing fetal number (Figure 1). Perinatal mortality rates varied by plurality, with triplet, quad, & quint rates calculated to be 9.6%, 12.1%, & 29.3%. Rates of fetal death, neonatal death, congenital anomaly, seizure, mechanical ventilation were 2.9%, 6.9%, 2.7%, 0.1%, & 15.8%, respectively, for triplets; 4.4%, 8.0%, 3.0%, 0.1%, & 21.7% for quads; and 8.8%, 22.5%, 1.0%, 0%, & 19.8% for quints.
358
CAN WE IDENTIFY WOMEN AT INCREASED RISK OF NOT SEEKING HELP FOLLOWING DOMESTIC ABUSE? RICHARD BENOIT1, 1Women & Infants’ Hospital, Providence, RI OBJECTIVE: To identify correlates of women experiencing domestic abuse who do not seek any form of help. This can lead to serious consequences, particularly in pregnancy, where correlates of battering are similar to those outside of pregnancy. STUDY DESIGN: The public access data set of the Chicago Women’s Health Risk Survey was obtained. Women receiving care at four clinical sites in urban Chicago were surveyed. 497 reporting abuse (30% pregnant) were asked about help-seeking (formal and informal) within the previous year. Univariate and bivariate analyses were performed. A dependent variable of interest, helpseek, was created to describe the types of help sought. Multivariate logistic regression and an ROC modeled the outcome helpseek, predicting probability of an abused women not seeking any help. RESULTS: 70% of the women were African American. 18% had not sought any help following abuse (helpseek = 0). Bivariate analyses revealed variables correlated with an increased odds of not seeking help included having children (OR 2.3, 95% CI 1.13-4.6), power score < 25th percentile (OR 2.86, 95% CI 1.65), harassment score < 25th percentile (OR 2.4, 95%CI 1.4-4.2), social support scale < 25th percentile (OR 2, 95%CI 1.19-3.36), partner having abused drugs (OR 2, 95%CI 1.2-3.4), and reported race black (OR 1.96, 95% CI 1.2-3.14). Multivariate logistic regression for the outcome helpseek = 0 revealed that the probability of being in the group of abused woman who did not seek help was increased with unemployment, a partner abusing drugs, low power and control scores, and low social support score. The ROC revealed that a probability of 0.5 as a positive screen had a sensitivity of 16%, specificity of 99%, and LR of 10.7 to predict not seeking help following abuse. CONCLUSION: Identifying correlates of women experiencing domestic abuse who do not seek help may improve screening and offers the potential for developing interventions to empower women to deal with their abuser effectively, and to seek timely assistance.
359
HOW USEFUL IS FIRST-TRIMESTER INCREASED NUCHAL TRANSLUCENCY AS A SCREENING TOOL FOR THE DETECTION OF CONGENITAL HEART DISEASE? RICHARD BENOIT1, 1Women & Infants’ Hospital, Providence, RI OBJECTIVE: To describe the diagnostic accuracy and utility of increased nuchal translucency (NT) thickness in the detection of congenital heart disease (CHD) with a meta-analysis. STUDY DESIGN: Selection criteria included population-based cohort studies, retrospective & prospective, describing the use of fetal nuchal translucency thickness between 10 and 14 weeks’ gestation for first-trimester screening. Antenatal and postnatal outcomes must have been assessed, particularly karyotype and prevalence of congenital heart anomalies. Studies included reported the outcome of a chromsomal normal cohort with respect to nuchal translucency thickness between 10 and 14 weeks’ gestation, allowing determination of relative risk, sensitivity, specificity, likelihood ratio, and risk difference for an abnormal test and congenital heart malformation (with 95% CI). The prevalence of CHD in the population screened was described as high or low. RESULTS: Five cohort studies met inclusion criteria (4 prospective, 1 retrospective). All five assessed a low-risk population, confirmed by prevalence range of 1.7 to 3.3 per 1000. Among three of the studies reporting a NT $2.5 mm as a cutoff for abnormal screen, sensitivity for the detection of congenital heart anomaly among chromosomally normal live births ranged from 15%-27%; specificity, 97%-99%, and likelihood ratio from 4.4 to 18.5. Among the two reporting NT $95th percentile with respect to crown-rump length norms, sensitivity ranged from 36%-56%; specificity, 94%-97%; and likelihood ratio, positive 9 to 10.8. For the three studies reporting NT $99th percentile or $3.5 mm, sensitivity ranged from 12%-40%; specificity, 99%; and likelihood ratio, positive 14.8 to 39. The risk difference for a NT $99% was 4%-6%. CONCLUSION: Nuchal translucency (NT) measurement between 10 and 14 weeks’ gestation is a useful screening tool in the low-risk population for the detection of congenital heart disease, warranting referral for fetal echocardiography.
Figure 1. Birthweight by gestational age for live births (grams vs weeks) CONCLUSION: Birthweight, length of gestation, and risk of mortality & morbidity in multiples are incrementally related to fetal number. Infants of multiple gestation should be evaluated using plurality-specific standards rather than singleton references.
357
MATERNAL DEPRESSIVE SYMPTOMATOLOGY AND PRETERM BIRTH ( < 35 WEEKS’ GESTATION) AMONG LOW-INCOME WOMEN KELLY MCCOLLUM1, ESTHER CHUNG2, JENNIFER CULHANE1, 1Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA 2 Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA OBJECTIVE: To assess the association between maternal depressive symptomatology and preterm birth. STUDY DESIGN: Women were enrolled at their first prenatal visit (mean GA ± SE: 13.7 ± 0.1 weeks) at public clinics in Philadelphia. Demographic, behavioral, and psychosocial data were obtained by interview. Participant data were linked to birth records to obtain gestational age at birth and other control variables. Maternal depressive symptomatology was measured by the Center for Epidemiologic Studies for Depression Scale (CES-D). Participants were classified into one of three groups based on their CES-D score: not depressed (ND; < 16), possibly depressed (PD;$16 and < 22), and probably depressed (PRD;$22). Preterm birth (PTB) was defined as a live birth of less than 35 weeks’ gestation. Participants were excluded if they had preeclampsia, chronic or pregnancy-related hypertension, diabetes, or renal disease. Multiple logistic regression was used to obtain the relative risk of delivering preterm among the depression groups and to control for confounders. RESULTS: A total of 1988 women were included in this analysis. The majority of participants were single (74%), U.S.-born (77%), low-income women (median yearly income: $5798) who did not have an education beyond high school (82%). About half were primiparous. Twenty-three percent were classified as PRD, 16% as PD, and 61% as ND. The incidence of PTB was 5.5%. After controlling for sociodemographic, biomedical, and behavioral characteristics, there was no statistically significant association between maternal depression and PTB: (1) PD vs ND: RR (95%CI): 0.93 (0.62-1.39), (2) PRD vs ND: RR (95%CI): 1.08 (0.77, 1.51). CONCLUSION: Maternal depressive symptomatology is not associated with an increased or decreased risk of preterm birth ( <35 weeks’ gestation) in lowincome, urban women.