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Impact of weight loss between pregnancies on recurrent preterm birth
S54 SMFM Abstracts 151 IMPACT OF WEIGHT LOSS BETWEEN PREGNANCIES ON RECURRENT PRETERM BIRTH AMY GOODWIN (F)1, LAURA LAFFINEUSE1, MARC COLLIN2, BRIAN MERCER1, 1 CASE-MetroHealth Medical Center, Reproductive Biology, Maternal-Fetal Medicine, Cleveland, Ohio, 2CASE-MetroHealth Medical Center, Reproductive Biology, Pediatrics, Cleveland, Ohio OBJECTIVE: Low maternal pre-pregnancy body-mass index (BMI) has been associated with preterm birth (PTB). Women delivering preterm are at increased for recurrent PTB. Our goal was to determine if change in BMI between pregnancies alters the risk of PTB in a 2nd pregnancy. STUDY DESIGN: From our electronic perinatal database, we identified women who delivered singleton gestations at our institution in both their first and second pregnancy. Women were grouped according to pre-pregnancy BMI (low: !18.5, normal: 18.5-24.9, overweight: 25-29.9, obese: O30 kg/m2) and according to change in actual BMI (‘‘increase’’: O5 kg/m2, ‘‘stable’’: within 5 kg/m2, ‘‘decrease’’: O5 kg/m2) between pregnancies. They were also grouped based on whether they increased, decreased or stayed within their BMI category (low, normal, overweight, obese). The risk of PTB was correlated to change in BMI as defined above. p!0.005 was considered significant. RESULTS: 1,241 women met inclusion criteria. PTB complicated 9.8% of 2nd pregnancies. Women with a PTB in their 1st pregnancy had more PTB in their 2nd than those with a term birth in their 1st pregnancy (33.6 v 8.0%, p!0.001). Women whose BMI decreased O5 kg/m2 had more frequent PTB in the 2nd pregnancy than those who did not (21.1 v 9.3%, p=0.01). For those with a term birth in the 1st pregnancy, PTB in the 2nd did not increase with declining BMI. However, for women with a PTB in the 1st pregnancy, PTB was more frequent in the 2nd if their BMI decreased by one or more BMI categories (53.8 v 27.6%, p=0.05) or if BMI decreased more than 5 kg/m2 (80.0 v 28.2%, p=0.01). CONCLUSION: Women whose BMI declines between pregnancies are at increased risk for PTB, particularly if they delivered a prior preterm gestation. Weight loss between pregnancies may be a preventable cause of preterm birth.
152 POLYMORPHISMS OF THE PROTEASE ACTIVATED RECEPTOR1 (PAR 1) GENE IS ASSOCIATED WITH PRETERM DELIVERY (PTD) BUT NOT WITH PREECLAMPSIA (PET) AND INTRAUTERINE GROWTH RESTRICTION (IUGR) SORINA GRANOVSKYGRISARU1, AHARON TEVET2, DEBORAH ELSTEIN3, GAYA CHICO3, MATAN J. COHEN2, RACHEL BAR-SHAVIT4, ARTHUR I. EIDELMAN6, ARNON SAMUELOFF7, GEONA ALTERESCU8, 1Shaare Zedek Medical Center, Ben Gurion University, Jerusalem, Israel, 2Shaare Zedek Medical Center, Jerusalem, Obstetrics and Gynecology, Jerusalem, Israel, 3Shaare Zedek Medical Center, Jerusalem, Medical Genetics Unit, Jerusalem, Israel, 4Tumor Biology, Hadassah Hospital and the Hebrew University, Jerusalem, Oncology&Tumor Biology, Jerusalem, Israel, 6Shaare Zedek Medical Center, Jerusalem, Pediatrics, Jerusalem, Israel, 7Shaare Zedek Medical Center, Ben Gurion University, Obstetrics and Gynecology, Jerusalem, Israel, 8Shaare Zedek Medical Center, Jerusalem, Genetics and Internal Medicine, Jerusalem, Israel OBJECTIVE: To determine the relationship between adverse pregnancy outcome and PAR1 gene polymorphisms. PAR1, thrombin receptor, located on endothelium, platelets and cytotrophoblasts, is implicated in hemostasis and a matrix metalloprotease receptor involved in tissue remodeling. PAR1 plays a critical role in early placentation. Two 5’ regulatory region polymorphisms of PAR1 influence coagulation and adhesion molecules expression. We hypothesized that PAR 1 variability may indicate a predisposition to defective early placentation and adverse pregnancy outcomes. STUDY DESIGN: Prospective study (2005). Blood from 32 mother-neonate (singletons) pairs of consecutive cases of complicated pregnancies: 14 (44%) PTD, 9 (28%) PET and 9 (28%) idiopathic IUGR were compared to 24 pairs of normal term deliveries. PCR amplification/ digestion with appropriated restriction endonucleases to identify the single nucleotide polymorphism ÿ1426 (C/T) (P1) and the13 bp insertion at ÿ506 (I/D) (P2). RESULTS: The maternal allele frequency of P1 wild type (C/C) heterozygote (C/T) and homozygous (T/T) were not significantly different between the pregnancies complicated by PET or IUGR and the normal ones (p=1). However 31% of the mothers with PTD (mean 31.5 G 3.5 weeks) carried the heterozygous allele vs 4.5 % in the full term deliveries. The allele frequency of P2 wild type (D/D), heterozygote (I/D) and homozygous (I/I) carried a similar pattern, with a frequency of 71% in the PTD vs 46% in the full term deliveries. Overall the maternal homozygous allele frequency was low for both polymorphisms in all groups (!2%). The neonatal genotype variation for both polymorphisms did not differ between the groups and was not significantly associated with adverse perinatal outcome. CONCLUSION: Maternal heterozygous allele state for P1 and P2 polymorphisms in the regulatory region of the PAR1 gene is associated with PTD and not PET and IUGR. The biological role of the homozygous state remains to be established. Tissue remodeling function rather than vascular function is suggested for these regulatory sites.
153 LABOR INDUCTION VERSUS EXPECTANT MANAGEMENT AT 34-36 WEEKS’ GESTATION IN PRETERM PREMATURE RUPTURE OF MEMBRANES AURE´LIE BERNIER DUPRE´ELLE1, FRANC¸OIS GOFFINET2, BASSAM HADDAD1, YVES VILLES3, DOMINIQUE CABROL2, GILLES KAYEM1, 1University Paris 12-Creteil, Obstetrics and Gynecology, Creteil, France, 2AP-HP Cochin Port-Royal, Obstetrics, Paris, France, 3PIFO University, Obstetrics, Poissy, France
OBJECTIVE: To compare maternal and perinatal outcomes between expectant management (EM) and labor induction (LI) at 34-36 6/7 weeks’ gestation (wks) in women with preterm premature rupture of membranes (pPROM). STUDY DESIGN: 387 patients having one of these two planned management were retrospectively analyzed. Inclusion criteria were pPROM women that delivered at 34-36 6/7 wks. Continuous variables were compared by ANOVA and categorical variables by chi-square tests. Logistic regression was performed to determine variables that were independently associated to respiratory distress syndrome (RDS). RESULTS: Mean gestational ages at delivery were 35 4/7 wks G 6 days in the EM group (n=219) and 35 3/7 wks G 7 days in the LI group (n=168, p=.05). Chorioamnionitis (4% vs 1%; p=.08) and neonatal infection with or without positive blood cultures (3% vs 1%; p=.20) tend to be higher in the EM group. Caesarean during labor was not different between the two groups (16% vs 17%; p=0.73). There was less RDS with intubation O24 hours in the EM group than in the LI group (1% vs 6%; p!.01). Multivariable logistic regression analysis revealed that the kind of planned management (EM or LI) and the mode of delivery were independently associated with RDS (see Table). Two pregnancies managed expectantly with undiagnosed intra uterine growth retardation resulted in fetal death. CONCLUSION: In pPROM patients, expectant management between 34-36 6/7 wks is associated with a decreased risk of RDS. However, the risk of fetal death associated to this management is important to consider. Risk factors for RDS in women with pPROM
EM group Cesarean during labor Planned cesarean
Adjusted odds ratio
95% CI
0.15 5.14 3.78
0.03-0.68 1.14-23.19 0.97-14.80
154 THE IMPACT OF HIGH BODY MASS INDEX ON THE PREDICTION OF SPONTANEOUS PRETERM BIRTH BY ULTRASONOGRAPHIC CERVICAL LENGTH ISRAEL HENDLER (F)1, 1NICHD MFMU Network, Rockville, Maryland OBJECTIVE: To determine whether maternal BMI should be considered when sonographic cervical length (CL) is used to assess the risk for spontaneous preterm birth (SPB). STUDY DESIGN: This is a secondary analysis of 2910 women from an observational multicenter preterm prediction study, for whom height and prepregnancy weight were available. Patients were classified by body mass index (BMI, kg/m2) into two groups: ‘‘normal weight’’ (NW) (BMI ! 25kg/m2) and ‘‘overweight and obese’’ (OWO) (BMI R 25 kg/m2). The rates of SPB ! 37 weeks were compared by different cervical length cutoffs between groups. Categorical variables were compared using the Chi-square test. Logistic regression was used to assess the impact of confounding variables on the relationship between SPB and CL. RESULTS: 1224 (42.1%) women were OWO. OWO women were older compared to NW women [(mean G standard deviation) 25.0 G 5.6 vs. 22.9 G 5.3 years old, p!0.0001] and 35.1 vs. 46.4% were nulliparous, respectively p!0.0001]. There was no difference in the rate of previous SPB or in the rate of a positive fetal fibronectin test when compared between the groups. OWO women had less SPB (7.2%) compared to NW women (12.4%, p!0.0001). The rate of SPB was lower for OWO vs. NW women when compared at different CL cutoffs (figure). After adjustment for previous SPB, race, parity, maternal age, fetal fibronectin, and education, the odds for SPB among OWO women with a CL % 25mm, were reduced (Odds ratio 0.5, 95% confidence interval; 0.25-0.99).
Comparison of SPB rates between NW and OWO women at dierent CL cutos CONCLUSION: High maternal BMI is associated with a lower risk of SPB in women with a short cervical length.
152 POLYMORPHISMS OF THE PROTEASE ACTIVATED RECEPTOR1 (PAR 1) GENE IS ASSOCIATED WITH PRETERM DELIVERY (PTD) BUT NOT WITH PREECLAMPSIA (PET) AND INTRAUTERINE GROWTH RESTRICTION (IUGR) SORINA GRANOVSKYGRISARU1, AHARON TEVET2, DEBORAH ELSTEIN3, GAYA CHICO3, MATAN J. COHEN2, RACHEL BAR-SHAVIT4, ARTHUR I. EIDELMAN6, ARNON SAMUELOFF7, GEONA ALTERESCU8, 1Shaare Zedek Medical Center, Ben Gurion University, Jerusalem, Israel, 2Shaare Zedek Medical Center, Jerusalem, Obstetrics and Gynecology, Jerusalem, Israel, 3Shaare Zedek Medical Center, Jerusalem, Medical Genetics Unit, Jerusalem, Israel, 4Tumor Biology, Hadassah Hospital and the Hebrew University, Jerusalem, Oncology&Tumor Biology, Jerusalem, Israel, 6Shaare Zedek Medical Center, Jerusalem, Pediatrics, Jerusalem, Israel, 7Shaare Zedek Medical Center, Ben Gurion University, Obstetrics and Gynecology, Jerusalem, Israel, 8Shaare Zedek Medical Center, Jerusalem, Genetics and Internal Medicine, Jerusalem, Israel OBJECTIVE: To determine the relationship between adverse pregnancy outcome and PAR1 gene polymorphisms. PAR1, thrombin receptor, located on endothelium, platelets and cytotrophoblasts, is implicated in hemostasis and a matrix metalloprotease receptor involved in tissue remodeling. PAR1 plays a critical role in early placentation. Two 5’ regulatory region polymorphisms of PAR1 influence coagulation and adhesion molecules expression. We hypothesized that PAR 1 variability may indicate a predisposition to defective early placentation and adverse pregnancy outcomes. STUDY DESIGN: Prospective study (2005). Blood from 32 mother-neonate (singletons) pairs of consecutive cases of complicated pregnancies: 14 (44%) PTD, 9 (28%) PET and 9 (28%) idiopathic IUGR were compared to 24 pairs of normal term deliveries. PCR amplification/ digestion with appropriated restriction endonucleases to identify the single nucleotide polymorphism ÿ1426 (C/T) (P1) and the13 bp insertion at ÿ506 (I/D) (P2). RESULTS: The maternal allele frequency of P1 wild type (C/C) heterozygote (C/T) and homozygous (T/T) were not significantly different between the pregnancies complicated by PET or IUGR and the normal ones (p=1). However 31% of the mothers with PTD (mean 31.5 G 3.5 weeks) carried the heterozygous allele vs 4.5 % in the full term deliveries. The allele frequency of P2 wild type (D/D), heterozygote (I/D) and homozygous (I/I) carried a similar pattern, with a frequency of 71% in the PTD vs 46% in the full term deliveries. Overall the maternal homozygous allele frequency was low for both polymorphisms in all groups (!2%). The neonatal genotype variation for both polymorphisms did not differ between the groups and was not significantly associated with adverse perinatal outcome. CONCLUSION: Maternal heterozygous allele state for P1 and P2 polymorphisms in the regulatory region of the PAR1 gene is associated with PTD and not PET and IUGR. The biological role of the homozygous state remains to be established. Tissue remodeling function rather than vascular function is suggested for these regulatory sites.
153 LABOR INDUCTION VERSUS EXPECTANT MANAGEMENT AT 34-36 WEEKS’ GESTATION IN PRETERM PREMATURE RUPTURE OF MEMBRANES AURE´LIE BERNIER DUPRE´ELLE1, FRANC¸OIS GOFFINET2, BASSAM HADDAD1, YVES VILLES3, DOMINIQUE CABROL2, GILLES KAYEM1, 1University Paris 12-Creteil, Obstetrics and Gynecology, Creteil, France, 2AP-HP Cochin Port-Royal, Obstetrics, Paris, France, 3PIFO University, Obstetrics, Poissy, France
OBJECTIVE: To compare maternal and perinatal outcomes between expectant management (EM) and labor induction (LI) at 34-36 6/7 weeks’ gestation (wks) in women with preterm premature rupture of membranes (pPROM). STUDY DESIGN: 387 patients having one of these two planned management were retrospectively analyzed. Inclusion criteria were pPROM women that delivered at 34-36 6/7 wks. Continuous variables were compared by ANOVA and categorical variables by chi-square tests. Logistic regression was performed to determine variables that were independently associated to respiratory distress syndrome (RDS). RESULTS: Mean gestational ages at delivery were 35 4/7 wks G 6 days in the EM group (n=219) and 35 3/7 wks G 7 days in the LI group (n=168, p=.05). Chorioamnionitis (4% vs 1%; p=.08) and neonatal infection with or without positive blood cultures (3% vs 1%; p=.20) tend to be higher in the EM group. Caesarean during labor was not different between the two groups (16% vs 17%; p=0.73). There was less RDS with intubation O24 hours in the EM group than in the LI group (1% vs 6%; p!.01). Multivariable logistic regression analysis revealed that the kind of planned management (EM or LI) and the mode of delivery were independently associated with RDS (see Table). Two pregnancies managed expectantly with undiagnosed intra uterine growth retardation resulted in fetal death. CONCLUSION: In pPROM patients, expectant management between 34-36 6/7 wks is associated with a decreased risk of RDS. However, the risk of fetal death associated to this management is important to consider. Risk factors for RDS in women with pPROM
EM group Cesarean during labor Planned cesarean
Adjusted odds ratio
95% CI
0.15 5.14 3.78
0.03-0.68 1.14-23.19 0.97-14.80
154 THE IMPACT OF HIGH BODY MASS INDEX ON THE PREDICTION OF SPONTANEOUS PRETERM BIRTH BY ULTRASONOGRAPHIC CERVICAL LENGTH ISRAEL HENDLER (F)1, 1NICHD MFMU Network, Rockville, Maryland OBJECTIVE: To determine whether maternal BMI should be considered when sonographic cervical length (CL) is used to assess the risk for spontaneous preterm birth (SPB). STUDY DESIGN: This is a secondary analysis of 2910 women from an observational multicenter preterm prediction study, for whom height and prepregnancy weight were available. Patients were classified by body mass index (BMI, kg/m2) into two groups: ‘‘normal weight’’ (NW) (BMI ! 25kg/m2) and ‘‘overweight and obese’’ (OWO) (BMI R 25 kg/m2). The rates of SPB ! 37 weeks were compared by different cervical length cutoffs between groups. Categorical variables were compared using the Chi-square test. Logistic regression was used to assess the impact of confounding variables on the relationship between SPB and CL. RESULTS: 1224 (42.1%) women were OWO. OWO women were older compared to NW women [(mean G standard deviation) 25.0 G 5.6 vs. 22.9 G 5.3 years old, p!0.0001] and 35.1 vs. 46.4% were nulliparous, respectively p!0.0001]. There was no difference in the rate of previous SPB or in the rate of a positive fetal fibronectin test when compared between the groups. OWO women had less SPB (7.2%) compared to NW women (12.4%, p!0.0001). The rate of SPB was lower for OWO vs. NW women when compared at different CL cutoffs (figure). After adjustment for previous SPB, race, parity, maternal age, fetal fibronectin, and education, the odds for SPB among OWO women with a CL % 25mm, were reduced (Odds ratio 0.5, 95% confidence interval; 0.25-0.99).
Comparison of SPB rates between NW and OWO women at dierent CL cutos CONCLUSION: High maternal BMI is associated with a lower risk of SPB in women with a short cervical length.