- Email: [email protected]
Gestational Weight Gain in Adolescent Mothers: Distribution and Perinatal Outcomes in a Canadian Population
e62
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78
sexually active, 21.6% had been pregnant before and 8.8% had a positive UPT during the clinic visit. The majority (89.9%) desired pregnancy “In the future (+3 yrs)” or “Never” and 10.1% desired pregnancy “Now (within this yr)” or “Soon (within 1-2 yrs)”. Most of the patients desiring pregnancy in the future/never (80.7%) used no method or a minimally effective method of contraception prior to the clinic visit; however, 85.5% selected a moderately or highly effective method of contraception during the clinic visit. Although there was no significant correlation between RLP and the efficacy of contraception used prior to the clinic visit, patients desiring pregnancy in the future/never were more likely to select a moderate/ highly effective method of contraception during the clinic visit (OR ¼ 0.56, p ¼ 0.27 vs. OR ¼ 4.59, p ¼ 0.01). In addition, patients desiring pregnancy in the future/never are more likely to use contraception prior to and after the clinic visit than patients desiring pregnancy now/soon (OR ¼ 3.24, p ¼ 0.03 and OR ¼ 6.43, p ¼ 0.05, respectively). Lastly, there was no significant correlation between RLP and UPT results (p ¼ 0.27). Conclusions: Our research demonstrates that an adolescent female’s RLP is consistent with her use and choice of contraception e making it a helpful and effective tool in patient-centered reproductive counseling. Furthermore, our study identified opportunities for intervention in two populations: 1) patients desiring pregnancy in the future/never but leaving the clinic visit with no method of contraception may benefit from patientcentered counseling focused on aligning her RLP with her use/choice of contraception and 2) patients desiring pregnancy now/soon may benefit from patient-centered counseling focused on identifying her reasons for desiring a pregnancy and discussing the implications of that decision.
49. Awareness and Knowledge of Long Acting Reversible Contraception Among Young Women on a College Campus Susan Ernst MD, Elizabeth Ela MA, Laura McAndrew MPH, Monique Steele MSN, Sneha Challa, Melissa K. Zowchowski MBA, Vanessa K. Dalton MD, MPH, Kelli Stidham Hall PhD, MS* University of Michigan, Ann Arbor, MI
Background: Long acting reversible contraceptives (LARC) are highly effective but underutilized methods to reduce unintended pregnancies among young women. We comprehensively assessed awareness and knowledge of intrauterine devices (IUDs) and implants among a cohort of college-aged women. Methods: We administered an internet-based survey to measure knowledge, perceptions, and experiences with LARC to 1,982 female undergraduates (mean age 20 years) at a large mid-western university. The 55item survey, which we designed for this study based upon a comprehensive literature review and our prior survey work, used forced choice, Likert scale and true/false items to measure multiple dimensions of women’s understanding of IUDs and implants, including self-reported awareness and general knowledge levels; specific knowledge of each method’s use, effectiveness, benefits, risks, and side effects; and LARC attitudes, beliefs, and misperceptions. We used descriptive statistics (proportions, means) to describe women’s LARC awareness and knowledge. This study was approved by the University of Michigan’s Institutional Review Board. Results: Less than a quarter (22%) of the sample had ever heard of “long acting reversible contraception (LARC).” Women reported “little” or “no” general knowledge of IUDs (55% and 24%, respectively) and implants (55% and 33%). “Don’t know” was a common response to a series of 21 true/false statements (range 20-65%), with proportions of “don’t know” being the highest for items focused on LARC mechanisms of action (MOA). Approximately half of women did not know whether an IUD can cause abortion (50%) or infertility (42%); proportions responding “don’t know” were also high for women’s understanding of whether “implants are less effective than IUDs because they are not placed inside the uterus” (62%) and whether “IUDs are more effective than contraceptive pills at preventing pregnancy” (42%). Additionally, incorrect responses to the true/false statements ranged from 1-31%, with proportions of incorrect responses being the highest for items focused on LARC MOA and side effects. A substantial proportion of women believed that “IUDs and implants contain both estrogen and progesterone” (31%) and that IUDs cause infertility (19%), weight gain (13%), and other side effects like hair loss, acne, or mood changes (16%).
Conclusions: Using a comprehensive approach to assess different, understudied dimensions of women’s understanding of IUDs and implants, we found that LARC awareness and knowledge was exceedingly low among our sample. Results on specific aspects of inadequate LARC knowledge are informing our web-based, population-level, campus tailored intervention designed to improve acceptability and understanding of highly effective contraception, ultimately to improve reproductive health outcomes for young women.
50. Gestational Weight Gain in Adolescent Mothers: Distribution and Perinatal Outcomes in a Canadian Population Vanessa Mongrain MD, BSc, Elise Dubuc MD, FRCSC* de Montre al, Montre al, Que bec, Canada Universite
Background: There are no specific gestational weight gain guidelines for adolescent mothers. The Institute of Medicine (IOM)’s most recent recommendations for weight gain in pregnancy 1 are used for the adolescent population, despite being based on adult BMI categories. We suspect that adolescent mothers in our population display gestational weight gains that are superior to what is recommended. Excessive gestational weight gain can lead to obstetrical complications2. More importantly, post-partum retention of this weight leads to early-onset obesity3,4 with long-term physical, psychological, and social consequences. The primary objective of this study is to examine the distribution of gestational weight gain in our adolescent population according to the IOM’s guidelines, and identify associations between gestational weight gain as well as obstetrical and perinatal outcomes. Methods: We are currently conducting a retrospective cohort study in our adolescent obstetrical population at Ste-Justine Hospital in Montreal, Canada. Data from over 380 patients who are twenty years old or under and have given birth at our center between 2003 and 2013 is currently being collected by chart review. The following information is obtained: demographic details, pre-pregnancy BMI, gestational weight gain, weight at postpartum visit, as well as obstetrical and perinatal outcomes (gestational diabetes, hypertensive disorders of pregnancy, preterm labour, shoulder dystocia, mode of delivery, birth weight, neonatal complications and breastfeeding status). The gestational weight gain for each patient is then classified according to the IOM’s guidelines as inferior to, appropriate, or superior to that recommended, based on the pre-pregnancy BMI. The association between each category of gestational weight gain with the following variables will then be measured: pre-pregnancy BMI, demographics and the obstetrical and perinatal outcomes stated above. Age, race, pre-pregnancy BMI, smoking and parity will be considered confounding factors in the multivariate regression analyses to be conducted. This study was approved by our institution’s review board. Results: Data collection is currently ongoing; so far, 97 patients have been included in the study. Preliminary results indicate that 43% of patients (n ¼ 42) displayed a gestational weight gain that is superior to the range recommended by the IOM, 32% (n ¼ 31) had a weight gain within recommendations and 25% (n ¼ 24) gained less than the recommended amount. Of those having gained an excessive amount, the majority (57%, n ¼ 24) had a pre-pregnancy BMI in the normal range. Moreover, 65% of subjects with a pre-pregnancy BMI in the overweight or obese category gained more than the recommended amount. Conclusion: Our preliminary data indicates that the majority of adolescent mothers in our population exhibit gestational weight gain that is superior to what is recommended by the IOM’s guidelines. Gestational weight gain in adolescent mother should be closely monitored and interventions should be put in place to limit excessive weight gain leading to development of early-onset obesity.
References 1. Institute of Medicine: Weight gain during pregnancy: reexamining the guidelines. The National Academies Press, 2009. 2. Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, Spong CY, et al: Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines. Obstet Gynecol 2013; 121(5):969e75.
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78 3. Joseph NP, Hunkali KB, Wilson B, Morgan E, Cross M, Freund KM: Pre-pregnancy body mass index among pregnant adolescents: gestational weight gain and long-term post partum weight retention. J Pediatr Adolesc Gynecol 2008; 21(4):195e200. 4. Groth SW: The long-term impact of adolescent gestational weight gain. Res Nurs Health 2008; 31(2):108e18.
51. Depot Medroxyprogesterone Acetate Use in Adolescents: A Weighty Matter Ashley Wanless MD, Seema Menon MD* Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
Background: Adolescents frequently express weight gain concerns when using depot medroxyprogesterone acetate (DMPA). This study evaluates weight gain associated with DMPA over an 11-13 month time period and seeks to characterize a sub-population that may be more vulnerable to DMPA associated weight gain. Method: A retrospective chart review was conducted between January 2010 and December 2013. ICD-9 codes were used to generate a list of participants from the Children’s Hospital of Wisconsin adolescent gynecology and medicine clinics. Exclusion criteria included: under age 12 or over age 21, prior use of hormonal contraception, incomplete weight or height documentation, selection of a long acting contraception method, hormone therapy use less than 11-13 months, or visit date outside of the study time frame. Height, weight, BMI, and BMI percentile were recorded at the initial visit and at 11-13 months. Ethnicity, gynecologic diagnosis, existing mood disorder, and type of hormone therapy were captured. Users of DMPA were grouped by ethnicity, age (12-14, 15-17, and 18-21), BMI percentile (< 5th, 5-85th, 85 to 95th, and > 95th), presence or absence of mood disorder, and diagnosis (PMS, PCOS/oligomenorrhea, and contraception). Weight change over 11-13 months between the groups was compared; ANOVA and t-test calculations were applied. A comparison of weight gain between participants using combination oral contraception pills (COC), DMPA, and no hormone therapy was done; multiple linear regression analysis was applied. SAS version 9.3 was used for the statistic calculations. Children’s Hospital of Wisconsin IRB approval was obtained. Results: Three hundred sixty eight charts were reviewed and 103 participants were eligible. Fifty-two chose COC, 48 chose DMPA and three chose no hormonal therapy. The mean initial weight of all participants was 63.75 kg; the mean weight 11-13 months after start was 67.19 kg. Mean weight gain for DMPA users was 4.9 kg +/-0.9, COC users gained 2.2 kg+/0.6 (p ¼ 0.013). Among DMPA users, younger participants and participants with elevated BMI gained more weight, although significant difference was not noted. (Table 1 and Table 2) Ethnicity (p ¼ 0.963), mood disorder diagnosis (p ¼ 0.750), and gynecologic diagnosis (p ¼ 0.804) were not significantly associated with weight gain in DMPA users. Conclusion: Users of DMPA gained significantly more weight than COC users over an 11-13 time period. Younger participants and those in an elevated BMI category gained more weight than younger, lower BMI participants using DMPA. Although this trend was not significant, the number Table 1 Weight Comparison of DMPA by age category
Average weight gain (kg)
AGE 12-14 (21 participants)
Age 15-17 (24 participants)
Age 18-21 (3 participants)
P Value
6.05
4.05
0.87
0.367
< 5th (0 5th to <85th P 85th to < 95th > 95th (12 participants) (29 participants) (7 participants) participants) Value 3.62
5.46
of participants in the sub-groups was low; a larger study is needed to better investigate if these groups of adolescents are more vulnerable to weight gain when using DMPA. 52. Etiology and Management of Abnormal Uterine Bleeding in Adolescents Admitted to a Children’s Hospital Over a Nine -Year Period, 2005-2013 Sofya Maslyanskaya MD, Hina J. Talib MD, Amanda M. Jacobs MD, Chanelle Coble-Sadaphal MD, Jennifer Northridge MD, Susan M. Coupey MD* Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
Background: Abnormal Uterine Bleeding (AUB) resulting in anemia is a common gynecologic reason for hospitalization of adolescent girls. Frequently reported etiologies include anovulation due to immaturity of the hypothalamic-pituitary-ovarian (HPO) axis and bleeding diatheses. There is a lack of consensus on the optimal inpatient treatment for adolescents with AUB. The objective of this study is to describe the etiology and management of AUB in urban, predominantly minority adolescents admitted to a children’s hospital with a protocol for assessing and managing girls with AUB. Methods: We used a patented software tool, Clinical Looking Glass, to search electronic health records and identified females aged eight to 20 years hospitalized with AUB and treated with hormones and/or antifibrinolytics from January 2005 through December 2013. Of the 241 patients identified for chart review, 140 had bleeding due to pregnancy complications or had no active uterine bleeding and were excluded. Of the 101 patients included in the study, to date, we have systematically reviewed the charts of 47 using a data extraction template. Data were extracted from the inpatient admission and subsequent outpatient visits. The study was approved by the Institutional Review Board. Student’s t test was used to compare different treatments by hospital length of stay (LOS). Results: Mean age of the 47 subjects was 16.8 2.8 years; 34% Hispanic; 49% black; mean body mass index 27.1 9 kg/m2; 66% with gynecologic age greater than three years; 47% sexually active. On the day of inpatient admission, mean hemoglobin was 7.2 1.8 gm/dL; 62% had uterine bleeding for > 15 days. Treatments included packed red blood cell transfusion (49%); combined oral contraceptive pills (89%); intravenous conjugated estrogens (77%); oral progestins (15%); antibiotics (9%); antifibrinolytics (4%); none had operative procedures. Mean LOS was 2.7 1.2 days. Of the 47 subjects, a subsequent outpatient visit was recorded for 34 (72%). Final etiology of AUB included HPO axis immaturity (28%); polycystic ovary syndrome (PCOS) (23%); bleeding diatheses (11%); endometritis (8%); thyroid dysfunction (4%); unknown (26%). The most common side effects recorded during the admission were nausea (60%) and dizziness (47%); no thromboembolic events were recorded during the inpatient admission or at subsequent outpatient visits. We found a near significant association of use of intravenous conjugated estrogens with reduced LOS (3.2 days vs. 2.5 days, p ¼ 0.06). There was no association of packed red blood cell transfusion with LOS (2.6 days vs. 2.7 days, p ¼ 0.39). Conclusions: This cohort of adolescents admitted with AUB is different than those in prior studies. Specifically, more than 80% were ethnic minorities, most were overweight or obese, and two thirds had a gynecologic age greater than three years. Unlike prior studies, nearly one quarter of the sample had anovulation due to PCOS as the etiology of AUB. Our protocoldriven management of AUB in teens is reflected by frequent use of intravenous conjugated estrogens which appear to be a safe treatment modality for AUB and may reduce LOS in this age group. 53. Acute Heavy Menstrual Bleeding as Presenting Symptom of Hashimoto’s Thyroiditis
Table 2 Weight Comparison of DMPA by BMI Percentile Category
Average weight gain (kg)
e63
7.55
Janeen L. Arbuckle MD, PhD, Kimberly H. Hoover MD* University of Alabama Birmingham, Birmingham, Alabama
0.203
Background: Adolescent hypothyroidism commonly presents with a decline in growth velocity, a decline in school performance, or a diffusely
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78
sexually active, 21.6% had been pregnant before and 8.8% had a positive UPT during the clinic visit. The majority (89.9%) desired pregnancy “In the future (+3 yrs)” or “Never” and 10.1% desired pregnancy “Now (within this yr)” or “Soon (within 1-2 yrs)”. Most of the patients desiring pregnancy in the future/never (80.7%) used no method or a minimally effective method of contraception prior to the clinic visit; however, 85.5% selected a moderately or highly effective method of contraception during the clinic visit. Although there was no significant correlation between RLP and the efficacy of contraception used prior to the clinic visit, patients desiring pregnancy in the future/never were more likely to select a moderate/ highly effective method of contraception during the clinic visit (OR ¼ 0.56, p ¼ 0.27 vs. OR ¼ 4.59, p ¼ 0.01). In addition, patients desiring pregnancy in the future/never are more likely to use contraception prior to and after the clinic visit than patients desiring pregnancy now/soon (OR ¼ 3.24, p ¼ 0.03 and OR ¼ 6.43, p ¼ 0.05, respectively). Lastly, there was no significant correlation between RLP and UPT results (p ¼ 0.27). Conclusions: Our research demonstrates that an adolescent female’s RLP is consistent with her use and choice of contraception e making it a helpful and effective tool in patient-centered reproductive counseling. Furthermore, our study identified opportunities for intervention in two populations: 1) patients desiring pregnancy in the future/never but leaving the clinic visit with no method of contraception may benefit from patientcentered counseling focused on aligning her RLP with her use/choice of contraception and 2) patients desiring pregnancy now/soon may benefit from patient-centered counseling focused on identifying her reasons for desiring a pregnancy and discussing the implications of that decision.
49. Awareness and Knowledge of Long Acting Reversible Contraception Among Young Women on a College Campus Susan Ernst MD, Elizabeth Ela MA, Laura McAndrew MPH, Monique Steele MSN, Sneha Challa, Melissa K. Zowchowski MBA, Vanessa K. Dalton MD, MPH, Kelli Stidham Hall PhD, MS* University of Michigan, Ann Arbor, MI
Background: Long acting reversible contraceptives (LARC) are highly effective but underutilized methods to reduce unintended pregnancies among young women. We comprehensively assessed awareness and knowledge of intrauterine devices (IUDs) and implants among a cohort of college-aged women. Methods: We administered an internet-based survey to measure knowledge, perceptions, and experiences with LARC to 1,982 female undergraduates (mean age 20 years) at a large mid-western university. The 55item survey, which we designed for this study based upon a comprehensive literature review and our prior survey work, used forced choice, Likert scale and true/false items to measure multiple dimensions of women’s understanding of IUDs and implants, including self-reported awareness and general knowledge levels; specific knowledge of each method’s use, effectiveness, benefits, risks, and side effects; and LARC attitudes, beliefs, and misperceptions. We used descriptive statistics (proportions, means) to describe women’s LARC awareness and knowledge. This study was approved by the University of Michigan’s Institutional Review Board. Results: Less than a quarter (22%) of the sample had ever heard of “long acting reversible contraception (LARC).” Women reported “little” or “no” general knowledge of IUDs (55% and 24%, respectively) and implants (55% and 33%). “Don’t know” was a common response to a series of 21 true/false statements (range 20-65%), with proportions of “don’t know” being the highest for items focused on LARC mechanisms of action (MOA). Approximately half of women did not know whether an IUD can cause abortion (50%) or infertility (42%); proportions responding “don’t know” were also high for women’s understanding of whether “implants are less effective than IUDs because they are not placed inside the uterus” (62%) and whether “IUDs are more effective than contraceptive pills at preventing pregnancy” (42%). Additionally, incorrect responses to the true/false statements ranged from 1-31%, with proportions of incorrect responses being the highest for items focused on LARC MOA and side effects. A substantial proportion of women believed that “IUDs and implants contain both estrogen and progesterone” (31%) and that IUDs cause infertility (19%), weight gain (13%), and other side effects like hair loss, acne, or mood changes (16%).
Conclusions: Using a comprehensive approach to assess different, understudied dimensions of women’s understanding of IUDs and implants, we found that LARC awareness and knowledge was exceedingly low among our sample. Results on specific aspects of inadequate LARC knowledge are informing our web-based, population-level, campus tailored intervention designed to improve acceptability and understanding of highly effective contraception, ultimately to improve reproductive health outcomes for young women.
50. Gestational Weight Gain in Adolescent Mothers: Distribution and Perinatal Outcomes in a Canadian Population Vanessa Mongrain MD, BSc, Elise Dubuc MD, FRCSC* de Montre al, Montre al, Que bec, Canada Universite
Background: There are no specific gestational weight gain guidelines for adolescent mothers. The Institute of Medicine (IOM)’s most recent recommendations for weight gain in pregnancy 1 are used for the adolescent population, despite being based on adult BMI categories. We suspect that adolescent mothers in our population display gestational weight gains that are superior to what is recommended. Excessive gestational weight gain can lead to obstetrical complications2. More importantly, post-partum retention of this weight leads to early-onset obesity3,4 with long-term physical, psychological, and social consequences. The primary objective of this study is to examine the distribution of gestational weight gain in our adolescent population according to the IOM’s guidelines, and identify associations between gestational weight gain as well as obstetrical and perinatal outcomes. Methods: We are currently conducting a retrospective cohort study in our adolescent obstetrical population at Ste-Justine Hospital in Montreal, Canada. Data from over 380 patients who are twenty years old or under and have given birth at our center between 2003 and 2013 is currently being collected by chart review. The following information is obtained: demographic details, pre-pregnancy BMI, gestational weight gain, weight at postpartum visit, as well as obstetrical and perinatal outcomes (gestational diabetes, hypertensive disorders of pregnancy, preterm labour, shoulder dystocia, mode of delivery, birth weight, neonatal complications and breastfeeding status). The gestational weight gain for each patient is then classified according to the IOM’s guidelines as inferior to, appropriate, or superior to that recommended, based on the pre-pregnancy BMI. The association between each category of gestational weight gain with the following variables will then be measured: pre-pregnancy BMI, demographics and the obstetrical and perinatal outcomes stated above. Age, race, pre-pregnancy BMI, smoking and parity will be considered confounding factors in the multivariate regression analyses to be conducted. This study was approved by our institution’s review board. Results: Data collection is currently ongoing; so far, 97 patients have been included in the study. Preliminary results indicate that 43% of patients (n ¼ 42) displayed a gestational weight gain that is superior to the range recommended by the IOM, 32% (n ¼ 31) had a weight gain within recommendations and 25% (n ¼ 24) gained less than the recommended amount. Of those having gained an excessive amount, the majority (57%, n ¼ 24) had a pre-pregnancy BMI in the normal range. Moreover, 65% of subjects with a pre-pregnancy BMI in the overweight or obese category gained more than the recommended amount. Conclusion: Our preliminary data indicates that the majority of adolescent mothers in our population exhibit gestational weight gain that is superior to what is recommended by the IOM’s guidelines. Gestational weight gain in adolescent mother should be closely monitored and interventions should be put in place to limit excessive weight gain leading to development of early-onset obesity.
References 1. Institute of Medicine: Weight gain during pregnancy: reexamining the guidelines. The National Academies Press, 2009. 2. Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, Spong CY, et al: Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines. Obstet Gynecol 2013; 121(5):969e75.
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78 3. Joseph NP, Hunkali KB, Wilson B, Morgan E, Cross M, Freund KM: Pre-pregnancy body mass index among pregnant adolescents: gestational weight gain and long-term post partum weight retention. J Pediatr Adolesc Gynecol 2008; 21(4):195e200. 4. Groth SW: The long-term impact of adolescent gestational weight gain. Res Nurs Health 2008; 31(2):108e18.
51. Depot Medroxyprogesterone Acetate Use in Adolescents: A Weighty Matter Ashley Wanless MD, Seema Menon MD* Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
Background: Adolescents frequently express weight gain concerns when using depot medroxyprogesterone acetate (DMPA). This study evaluates weight gain associated with DMPA over an 11-13 month time period and seeks to characterize a sub-population that may be more vulnerable to DMPA associated weight gain. Method: A retrospective chart review was conducted between January 2010 and December 2013. ICD-9 codes were used to generate a list of participants from the Children’s Hospital of Wisconsin adolescent gynecology and medicine clinics. Exclusion criteria included: under age 12 or over age 21, prior use of hormonal contraception, incomplete weight or height documentation, selection of a long acting contraception method, hormone therapy use less than 11-13 months, or visit date outside of the study time frame. Height, weight, BMI, and BMI percentile were recorded at the initial visit and at 11-13 months. Ethnicity, gynecologic diagnosis, existing mood disorder, and type of hormone therapy were captured. Users of DMPA were grouped by ethnicity, age (12-14, 15-17, and 18-21), BMI percentile (< 5th, 5-85th, 85 to 95th, and > 95th), presence or absence of mood disorder, and diagnosis (PMS, PCOS/oligomenorrhea, and contraception). Weight change over 11-13 months between the groups was compared; ANOVA and t-test calculations were applied. A comparison of weight gain between participants using combination oral contraception pills (COC), DMPA, and no hormone therapy was done; multiple linear regression analysis was applied. SAS version 9.3 was used for the statistic calculations. Children’s Hospital of Wisconsin IRB approval was obtained. Results: Three hundred sixty eight charts were reviewed and 103 participants were eligible. Fifty-two chose COC, 48 chose DMPA and three chose no hormonal therapy. The mean initial weight of all participants was 63.75 kg; the mean weight 11-13 months after start was 67.19 kg. Mean weight gain for DMPA users was 4.9 kg +/-0.9, COC users gained 2.2 kg+/0.6 (p ¼ 0.013). Among DMPA users, younger participants and participants with elevated BMI gained more weight, although significant difference was not noted. (Table 1 and Table 2) Ethnicity (p ¼ 0.963), mood disorder diagnosis (p ¼ 0.750), and gynecologic diagnosis (p ¼ 0.804) were not significantly associated with weight gain in DMPA users. Conclusion: Users of DMPA gained significantly more weight than COC users over an 11-13 time period. Younger participants and those in an elevated BMI category gained more weight than younger, lower BMI participants using DMPA. Although this trend was not significant, the number Table 1 Weight Comparison of DMPA by age category
Average weight gain (kg)
AGE 12-14 (21 participants)
Age 15-17 (24 participants)
Age 18-21 (3 participants)
P Value
6.05
4.05
0.87
0.367
< 5th (0 5th to <85th P 85th to < 95th > 95th (12 participants) (29 participants) (7 participants) participants) Value 3.62
5.46
of participants in the sub-groups was low; a larger study is needed to better investigate if these groups of adolescents are more vulnerable to weight gain when using DMPA. 52. Etiology and Management of Abnormal Uterine Bleeding in Adolescents Admitted to a Children’s Hospital Over a Nine -Year Period, 2005-2013 Sofya Maslyanskaya MD, Hina J. Talib MD, Amanda M. Jacobs MD, Chanelle Coble-Sadaphal MD, Jennifer Northridge MD, Susan M. Coupey MD* Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
Background: Abnormal Uterine Bleeding (AUB) resulting in anemia is a common gynecologic reason for hospitalization of adolescent girls. Frequently reported etiologies include anovulation due to immaturity of the hypothalamic-pituitary-ovarian (HPO) axis and bleeding diatheses. There is a lack of consensus on the optimal inpatient treatment for adolescents with AUB. The objective of this study is to describe the etiology and management of AUB in urban, predominantly minority adolescents admitted to a children’s hospital with a protocol for assessing and managing girls with AUB. Methods: We used a patented software tool, Clinical Looking Glass, to search electronic health records and identified females aged eight to 20 years hospitalized with AUB and treated with hormones and/or antifibrinolytics from January 2005 through December 2013. Of the 241 patients identified for chart review, 140 had bleeding due to pregnancy complications or had no active uterine bleeding and were excluded. Of the 101 patients included in the study, to date, we have systematically reviewed the charts of 47 using a data extraction template. Data were extracted from the inpatient admission and subsequent outpatient visits. The study was approved by the Institutional Review Board. Student’s t test was used to compare different treatments by hospital length of stay (LOS). Results: Mean age of the 47 subjects was 16.8 2.8 years; 34% Hispanic; 49% black; mean body mass index 27.1 9 kg/m2; 66% with gynecologic age greater than three years; 47% sexually active. On the day of inpatient admission, mean hemoglobin was 7.2 1.8 gm/dL; 62% had uterine bleeding for > 15 days. Treatments included packed red blood cell transfusion (49%); combined oral contraceptive pills (89%); intravenous conjugated estrogens (77%); oral progestins (15%); antibiotics (9%); antifibrinolytics (4%); none had operative procedures. Mean LOS was 2.7 1.2 days. Of the 47 subjects, a subsequent outpatient visit was recorded for 34 (72%). Final etiology of AUB included HPO axis immaturity (28%); polycystic ovary syndrome (PCOS) (23%); bleeding diatheses (11%); endometritis (8%); thyroid dysfunction (4%); unknown (26%). The most common side effects recorded during the admission were nausea (60%) and dizziness (47%); no thromboembolic events were recorded during the inpatient admission or at subsequent outpatient visits. We found a near significant association of use of intravenous conjugated estrogens with reduced LOS (3.2 days vs. 2.5 days, p ¼ 0.06). There was no association of packed red blood cell transfusion with LOS (2.6 days vs. 2.7 days, p ¼ 0.39). Conclusions: This cohort of adolescents admitted with AUB is different than those in prior studies. Specifically, more than 80% were ethnic minorities, most were overweight or obese, and two thirds had a gynecologic age greater than three years. Unlike prior studies, nearly one quarter of the sample had anovulation due to PCOS as the etiology of AUB. Our protocoldriven management of AUB in teens is reflected by frequent use of intravenous conjugated estrogens which appear to be a safe treatment modality for AUB and may reduce LOS in this age group. 53. Acute Heavy Menstrual Bleeding as Presenting Symptom of Hashimoto’s Thyroiditis
Table 2 Weight Comparison of DMPA by BMI Percentile Category
Average weight gain (kg)
e63
7.55
Janeen L. Arbuckle MD, PhD, Kimberly H. Hoover MD* University of Alabama Birmingham, Birmingham, Alabama
0.203
Background: Adolescent hypothyroidism commonly presents with a decline in growth velocity, a decline in school performance, or a diffusely