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O076 INFLUENCE OF SMOKING AND SNUFF CESSATION ON RISK OF SMALL-FOR-GESTATIONAL-AGE BIRTHS
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
was that the respondent must have been enrolled in the programme for a minimum of 6 months prior to conception. Results: The mean age was 30.32 years. Majority of the pregnancies were planned (67.4%). Having more children was the reason for getting pregnant (61.4%). Unprotected sexual intercourse, despite being unaware of their viral load by 68.8% of the respondents was the mode of getting pregnant in 94.4% of cases. Many (48.2%) of their partners were negative and 231 (76.7%) were aware of the woman’s status before getting pregnant. Two hundred and eight (69.1%) respondent had no counseling on contraception methods but 182 (60.5%) had been using contraception since HIV diagnosis. The use of HAART was positively correlated to desire to get pregnant (p = 0.004). Conclusions: The study showed that being HIV positive has no negative effect on PLWHIV fertility desires. Worrisome are the unsafe sexual behaviours associated with fulfilling such desires. There is, therefore, need to strengthen safer sex practice counseling, make provisions for risk reduction fertility procedures to ensure a good balance of achieving desired reproductive right and preventing hererosexual and vertical HIV transmission. O075 ASSESSMENT OF PRACTICAL KNOWLEDGE AND EXPERIENCE IN ARTIFICIAL INSEMINATION AMONG GYNAECOLOGY RESIDENTS IN A NIGERIAN UNIVERSITY TEACHING HOSPITAL A.A. Ayodele1 , K. Rabiu1 . 1 Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Lagos, Lagos, Nigeria Objectives: To assess the knowledge, and practical experience in artifical insemination among gynaecology residents in a tertiary gynaecological centre in a low resource setting. To assess the source of their knowledge, and to determine whether there is a need for improved practical content of reproductive health in the training of specialists in low resource regions of the world. Materials: Twenty (20) resident doctors undergoing specialist training at lagos state university teaching hospital were interviewed with the aid of a structured questionaire. Methods: The questionaire seeks to elicit their age, gender distribution, year of graduation from medical school, experience in private and public institutions. Questions were also asked to assess their knowledge of artificial insemination, method of sperm preparations and indications for insemination. The results were statistically analyzed and stated in simple percentages, tables and ratios. Results: All have been involved in the management of infertile couples in their clinical training and practice. 85% of the interviewed residents demonstrated good knowledge on he subjetof artificial insemination as a treatment option for infertile couples, including its indication and limitations. 70% of those with adequate knowledge on the subject attribute their knowledge to textbook studies, internet and clinical teaching by their overseeing consultants. Only 4 residents had participated or watched an insemination session, while two residents had participated in controlled ovarian stimiulation and ovum retrieval (art). The 4 residents believe, they could independently initiate and supervise an insemination cycle. Conclusions: There is demonstration of good knowledge of artificial insemination among gynaecologicalresidents studied. Self motivated study rather than practical experience formed the major source of their knowledge. This could adversely jeopardise a concerted effort to improve infertility management in low resource regions of the world. There is a need for improved practical content of reproductive health in the training of specialists in low resource regions of the world
S287
O076 INFLUENCE OF SMOKING AND SNUFF CESSATION ON RISK OF SMALL-FOR-GESTATIONAL-AGE BIRTHS S. Baba1 , A.-K. Wikstrom ¨ 1 , O. Stephansson1 , S. Cnattingius1 . 1 Karolinska Institutet, Department of Medicine, Solna, Stockholm, Sweden Objectives: Small-for-Gestational-Age (SGA) infants have increased morbidity and mortality as well as long term adverse health and developmental outcomes. Prenatal smoking exposure is associated with increased risk of giving birth to a SGA infant, but the mechanism remains unknown. In Sweden, oral moist snuff is also used among young women. Fetuses prenatally exposed to maternal smoking are exposed to both nicotine and tobacco combustion products, whereas fetuses prenatally exposed to maternal snuff use are only exposed to nicotine. Whether use of Swedish snuff during pregnancy is associated with increased risk of giving birth to a SGA infant is not known. The aim of this study was to examine associations between snuff use and smoking early in pregnancy and risks of SGA births. Materials: A nation-wide study of 779,495 live singleton births in Sweden from 1999 to 2009 were used. Methods: Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate relative risks for giving birth to an SGA infant in women who used snuff both 3 months before and in early pregnancy (continued snuff user; N = 8,228); in women who used snuff 3 months before pregnancy, but had stopped in early pregnancy (snuff quitter; N = 11,944); in women who smoked both 3 months before and in early pregnancy (continued smoker; N = 69,965); and in women who smoked 3 months before pregnancy, but had stopped in early pregnancy (smoking quitter; N = 78,502), using women who used no tobacco either 3 months before or in early pregnancy (non-tobacco user; N = 605,346) as reference. Results: Compared with non-tobacco users, continued snuff users and smokers had increased risks of SGA births (adjusted OR = 1.27, 95% CI: 1.09–1.48, adjusted OR = 2.54, 95% CI: 2.42–2.66, respectively) and had associations with both preterm and term SGA births. However, compared with non-tobacco users, snuff quitters had an even lower risk of giving birth to a SGA infant (OR = 0.83, 95% CI: 0.72–0.96) whereas smoking quitters had a similar risk (OR = 1.03, 95% CI: 0.98–1.09). Conclusions: The use of Swedish snuff during pregnancy increases the risk of giving birth to a SGA infant. Therefore, nicotine is most likely involved in the mechanisms by which maternal use of tobacco increases the risk of SGA. Women should be advised to quit smoking and use of snuff in early pregnancy to reduce their risk of SGA birth. O077 CORRELATION OF BODY MASS INDEX WITH OVARIAN RESERVE IN INFERTILE WOMEN UNDERGOING IVF IN A DEVELOPING COUNTRY A. Bahadur1 , N. Malhotra1 , N. Singh1 , M. Kalaivani1 , L. Chawla1 , S. Mital1 . 1 All India Institute of Medical Sciences, New Delhi, India Objectives: Obesity is associated with adverse reproductive outcome including sub fertility. The mechanism by which obesity affects fertility is complex and multi-factorial. Obese women require higher doses of Gonadotropins and respond poorly to ovarian stimulation during Assisted Reproduction Techniques. Whether there is a compromise the ovarian reserve in women with high BMI is not explored. In this prospective observational study we investigated the association between obesity and ovarian reserve in infertile women undergoing IVF in a developing country. Materials: This prospective observational study on 183 women was carried out in the infertility clinic of All India Institute of Medical Sciences, New Delhi, India. Methods: Blood hormonal assay in all patients including FSH, LH and Inhibin B was performed on day 2/3 of a spontaneous
was that the respondent must have been enrolled in the programme for a minimum of 6 months prior to conception. Results: The mean age was 30.32 years. Majority of the pregnancies were planned (67.4%). Having more children was the reason for getting pregnant (61.4%). Unprotected sexual intercourse, despite being unaware of their viral load by 68.8% of the respondents was the mode of getting pregnant in 94.4% of cases. Many (48.2%) of their partners were negative and 231 (76.7%) were aware of the woman’s status before getting pregnant. Two hundred and eight (69.1%) respondent had no counseling on contraception methods but 182 (60.5%) had been using contraception since HIV diagnosis. The use of HAART was positively correlated to desire to get pregnant (p = 0.004). Conclusions: The study showed that being HIV positive has no negative effect on PLWHIV fertility desires. Worrisome are the unsafe sexual behaviours associated with fulfilling such desires. There is, therefore, need to strengthen safer sex practice counseling, make provisions for risk reduction fertility procedures to ensure a good balance of achieving desired reproductive right and preventing hererosexual and vertical HIV transmission. O075 ASSESSMENT OF PRACTICAL KNOWLEDGE AND EXPERIENCE IN ARTIFICIAL INSEMINATION AMONG GYNAECOLOGY RESIDENTS IN A NIGERIAN UNIVERSITY TEACHING HOSPITAL A.A. Ayodele1 , K. Rabiu1 . 1 Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Lagos, Lagos, Nigeria Objectives: To assess the knowledge, and practical experience in artifical insemination among gynaecology residents in a tertiary gynaecological centre in a low resource setting. To assess the source of their knowledge, and to determine whether there is a need for improved practical content of reproductive health in the training of specialists in low resource regions of the world. Materials: Twenty (20) resident doctors undergoing specialist training at lagos state university teaching hospital were interviewed with the aid of a structured questionaire. Methods: The questionaire seeks to elicit their age, gender distribution, year of graduation from medical school, experience in private and public institutions. Questions were also asked to assess their knowledge of artificial insemination, method of sperm preparations and indications for insemination. The results were statistically analyzed and stated in simple percentages, tables and ratios. Results: All have been involved in the management of infertile couples in their clinical training and practice. 85% of the interviewed residents demonstrated good knowledge on he subjetof artificial insemination as a treatment option for infertile couples, including its indication and limitations. 70% of those with adequate knowledge on the subject attribute their knowledge to textbook studies, internet and clinical teaching by their overseeing consultants. Only 4 residents had participated or watched an insemination session, while two residents had participated in controlled ovarian stimiulation and ovum retrieval (art). The 4 residents believe, they could independently initiate and supervise an insemination cycle. Conclusions: There is demonstration of good knowledge of artificial insemination among gynaecologicalresidents studied. Self motivated study rather than practical experience formed the major source of their knowledge. This could adversely jeopardise a concerted effort to improve infertility management in low resource regions of the world. There is a need for improved practical content of reproductive health in the training of specialists in low resource regions of the world
S287
O076 INFLUENCE OF SMOKING AND SNUFF CESSATION ON RISK OF SMALL-FOR-GESTATIONAL-AGE BIRTHS S. Baba1 , A.-K. Wikstrom ¨ 1 , O. Stephansson1 , S. Cnattingius1 . 1 Karolinska Institutet, Department of Medicine, Solna, Stockholm, Sweden Objectives: Small-for-Gestational-Age (SGA) infants have increased morbidity and mortality as well as long term adverse health and developmental outcomes. Prenatal smoking exposure is associated with increased risk of giving birth to a SGA infant, but the mechanism remains unknown. In Sweden, oral moist snuff is also used among young women. Fetuses prenatally exposed to maternal smoking are exposed to both nicotine and tobacco combustion products, whereas fetuses prenatally exposed to maternal snuff use are only exposed to nicotine. Whether use of Swedish snuff during pregnancy is associated with increased risk of giving birth to a SGA infant is not known. The aim of this study was to examine associations between snuff use and smoking early in pregnancy and risks of SGA births. Materials: A nation-wide study of 779,495 live singleton births in Sweden from 1999 to 2009 were used. Methods: Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate relative risks for giving birth to an SGA infant in women who used snuff both 3 months before and in early pregnancy (continued snuff user; N = 8,228); in women who used snuff 3 months before pregnancy, but had stopped in early pregnancy (snuff quitter; N = 11,944); in women who smoked both 3 months before and in early pregnancy (continued smoker; N = 69,965); and in women who smoked 3 months before pregnancy, but had stopped in early pregnancy (smoking quitter; N = 78,502), using women who used no tobacco either 3 months before or in early pregnancy (non-tobacco user; N = 605,346) as reference. Results: Compared with non-tobacco users, continued snuff users and smokers had increased risks of SGA births (adjusted OR = 1.27, 95% CI: 1.09–1.48, adjusted OR = 2.54, 95% CI: 2.42–2.66, respectively) and had associations with both preterm and term SGA births. However, compared with non-tobacco users, snuff quitters had an even lower risk of giving birth to a SGA infant (OR = 0.83, 95% CI: 0.72–0.96) whereas smoking quitters had a similar risk (OR = 1.03, 95% CI: 0.98–1.09). Conclusions: The use of Swedish snuff during pregnancy increases the risk of giving birth to a SGA infant. Therefore, nicotine is most likely involved in the mechanisms by which maternal use of tobacco increases the risk of SGA. Women should be advised to quit smoking and use of snuff in early pregnancy to reduce their risk of SGA birth. O077 CORRELATION OF BODY MASS INDEX WITH OVARIAN RESERVE IN INFERTILE WOMEN UNDERGOING IVF IN A DEVELOPING COUNTRY A. Bahadur1 , N. Malhotra1 , N. Singh1 , M. Kalaivani1 , L. Chawla1 , S. Mital1 . 1 All India Institute of Medical Sciences, New Delhi, India Objectives: Obesity is associated with adverse reproductive outcome including sub fertility. The mechanism by which obesity affects fertility is complex and multi-factorial. Obese women require higher doses of Gonadotropins and respond poorly to ovarian stimulation during Assisted Reproduction Techniques. Whether there is a compromise the ovarian reserve in women with high BMI is not explored. In this prospective observational study we investigated the association between obesity and ovarian reserve in infertile women undergoing IVF in a developing country. Materials: This prospective observational study on 183 women was carried out in the infertility clinic of All India Institute of Medical Sciences, New Delhi, India. Methods: Blood hormonal assay in all patients including FSH, LH and Inhibin B was performed on day 2/3 of a spontaneous