- Email: [email protected]
OS029. Severe anemia, sickle cell disease, and thalassemia as riskfactors for preeclampsia in developing countries
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239
ysis was used to examine which maternal characteristics provided a significant contribution in the prediction of these adverse pregnancy outcomes. Crude and adjusted odds ratios (ORs) were derived for each pregnancy outcome. Results: Seventy five thousand and four hundred women were included in the study, of whom 57,564 were Caucasian and 11,395 African. Compared to Caucasian ethnic origin, African women were more likely to develop PE [OR (95% CI): 2.77 (2.49–3.09), p < 0.0001], GH [OR 1.38 (1.23–1.56), p < 0.0001], SGA [OR 3.48 (3.16–3.83), p < 0.0001], stillbirth [OR 2.42 (1.87–3.12), p < 0.0001], GDM [OR 1.82 (1.59– 2.07), p < 0.0001], PTD prior to 37 weeks gestation [OR 1.33 (1.23–1.44), p < 0.0001], and emergency CS [OR 2.42 (1.87– 3.12), p < 0.0001]. On the other hand, African women were less likely to develop LGA and OC [OR (95% CI): 0.63 (0.58– 0.67) and 0.47 (0.32–0.69) respectively; p < 0.0001 for both]. Conclusion: Compared to Caucasian ethnic background, women of African origin have a different risk profile for adverse pregnancy outcomes. This difference should be taken into account when calculating an individualised adjusted risk or when tailoring antenatal care.
191
square = 39.11, p < .001) with gestational hypertension more common in Whites, chronic hypertension in African Americans, and mild preeclampsia in Hispanics. The overall incidence of preeclampsia was lower in Hispanics. However, severe preeclampsia rates were equal across groups. Hispanics were more likely to be uninsured, younger, enter prenatal care later, and least likely to complete high school. There was no significant difference in smoking or parity. Stratified analyses by ethnicity showed that the relationship between severe preeclampsia and comorbidities (IUGR, LBW, ICN admission) were least pronounced in Hispanics and strongest in African American women. Conclusion: Despite similar rates of severe preeclampsia and adverse sociodemographic characteristics, Hispanic women with severe preeclampsia had better pregnancy outcomes than African–American or White women with the disease.
Disclosure of interest None declared.
Disclosure of interest
doi:10.1016/j.preghy.2012.04.029
None declared. doi:10.1016/j.preghy.2012.04.028
OS028. Hypertensive disease in pregnancy: An examination of ethnic differences and the Hispanic paradox M. Small 1,*, A. Carr 2, T. Kershaw 3, H. Brown 4 (1 Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, United States, 2 Obstetrics and Gynecology, Associates for Women’s Healthcare, Louisville, United States, 3 Epidmiology and Public Health, Yale University School of Public Health, New Haven, United States, 4 Obstetrics and Gynecology, Duke University School of Medicine, Durham, United States) Introduction: The ‘‘Hispanic Paradox’’ refers to the epidemiological finding that Hispanics in the US have better health outcomes than the average population despite what their aggregate socioeconomic determinants would predict. Objectives: The aim of this study was to evaluate obstetric outcomes for a multiethnic population with hypertensive diseases. Methods: We performed a retrospective review of parturients with hypertensive disease delivering at Duke University Medical Center in 2005–2007. We analyzed maternal sociodemographic characteristics and ethnic differences in hypertensive disease types using Chi Square. We assessed the role of race and ethnicity on maternal and neonatal outcomes through a series of logistic regression analyses. Results: Nine thousand eight hundred and thirteen women delivered during the study period, and 9% had hypertensive diseases in pregnancy. There were significant racial and ethnic differences in presentation (Chi-
OS029. Severe anemia, sickle cell disease, and thalassemia as risk factors for preeclampsia in developing countries J.J. Zhang 1,*, J. Grewal 2, M. Roosen-Runge 2, A.P. Betran Lazaga 3, J.P. Souza 3, M. Widmer 3, M. Merialdi 3 (1 Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 2 NICHD, NIH, Bethesda, United States, 3 Reproductive Health and Research, WHO, Geneva, Switzerland) Introduction: Hypertensive disorders during pregnancy contribute greatly to maternal and perinatal morbidity and mortality in developing countries. The pathogenesis of such conditions may be illuminated by exploring their relationship to anemia. Objectives: To determine whether several types of anemia are risk factors for hypertensive disorders during pregnancy in developing countries. Methods: Using data from the World Health Organization Global Survey for Maternal and Perinatal Health, collected in hospitals in six African and six Latin American countries from 2007 to 2008 and in four Asian countries from 2004 to 2005, we examined the associations between severe anemia, sickle cell disease and thalassemia and gestational hypertension or preeclampsia/eclampsia. After exclusions for comorbidities (chronic hypertension, diabetes, HIV infection) and missing data, the severe anemia, sickle cell disease, and thalassemia groups consisted of 219,627, 117,383, and 9376 women, respectively. Results: Multiparous women with severe anemia were at an increased risk of gestational hypertension (adjusted odds ratio (OR): 1.58; 95% confidence interval (CI): 1.15–2.19). Severe anemia had a significant association with preeclampsia/eclampsia for nulliparous (OR: 3.55; 95% CI: 2.87–4.41) and multiparous (OR: 3.94; 95% CI: 3.05–5.09) women.
192
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239
Sickle cell disease exhibited a significant association with gestational hypertension among nulliparous (OR: 2.49; 95% CI: 1.46–4.25) and multiparous (OR: 3.27; 95% CI: 2.33– 4.58) women. No significant associations were found between sickle cell disease and preeclampsia/eclampsia, or between thalassemia and either gestational hypertension or preeclampsia/eclampsia. Conclusion: Severe anemia appears to be a risk factor for preeclampsia/eclampsia, while sickle cell disease appears to be a risk factor for gestational hypertension among women seeking hospital care in developing countries.
Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.030
OS030. Hypertension and labor duration: Does it take longer? J.M. Bregand-White *, M. Kominiarek, J.U. Hibbard Consortium on Safe Labor (Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, United States) Introduction: Hypertensive disease in pregnancy carries higher maternal and fetal morbidity and mortality and often requires labor induction to minimize risk. It was previously taught that preeclampsia was associated with a more rapid progression through all stages of labor, while there is a paucity of data in other hypertensive categories. One investigation in preeclamptic women demonstrated that labor progress was prolonged with increased risk for cesarean delivery. Objectives: To study labor progression in induced nulliparas at term with hypertensive diseases in pregnancy. Methods: Retrospective cohort study using data from the Consortium on Safe Labor; a multicenter project that abstracted labor and delivery information from electronic medical records in 19 hospitals across the US. A total of 32,276 women with singleton term gestation, induced labor, and vertex presentation were studied. Hypertensive women were grouped into 4 separate categories: chronic
hypertension (cHTN), gestational hypertension (gHTN), preeclampsia (PreE) and superimposed preeclampsia (SIPreE) and compared to controls (no hypertensive disorder). For the first stage of labor, Interval-censored regression analysis was used to estimate median and 95th % duration of labor, centimeter by centimeter and from 4– 10 cm. Results: Significant differences were noted in demographics between each group and controls including age, race, labor admission body mass index, gestational age at delivery, comorbidities, and admission cervical dilation (P < 0.01 for all comparisons to the control group). As noted in the table, women with cHTN and SIPreE had a longer first stage of labor, gHTN had a shorter first stage of labor, and labor length was similar in PreE compared to controls. Second stage of labor was longer (5–41 min) with epidural and varied among groups; however, the clinical significance is limited. 95th% for progression from 4–10 cm in cHTN, SIPreE and gHTN were 27.4, 28.2 and 16.5 h respectively (controls 20.1 h). Conclusion: In nulliparas induced at term with hypertensive disease, labor progression in the first and second stage varies from controls. gHTN women have the shortest first stage of labor while PreE gravidas have labor patterns similar to controls. As cHTN and SIPreE women have a longer first stage, allowing labor to continue for a longer period in these gravidas may contribute to a reduced rate of cesarean delivery in the US, but will require further investigation.
Disclosure of interest None declared doi:10.1016/j.preghy.2012.04.031
OS031. Lifestyle intervention after complicated pregnancy successfully improves cardiovascular and metabolic health: Results of the pro-active study D. Berks 1,*, M. Hoedjes 2, A. Franx 3, H.J. Duvekot 1, H. Raat 2, E.A. Steegers 1 (1 Obstetrics and Gynecology, UMCU, Utrecht, Netherlands, 2 Public Health, Erasmus MC, Rotterdam,
ysis was used to examine which maternal characteristics provided a significant contribution in the prediction of these adverse pregnancy outcomes. Crude and adjusted odds ratios (ORs) were derived for each pregnancy outcome. Results: Seventy five thousand and four hundred women were included in the study, of whom 57,564 were Caucasian and 11,395 African. Compared to Caucasian ethnic origin, African women were more likely to develop PE [OR (95% CI): 2.77 (2.49–3.09), p < 0.0001], GH [OR 1.38 (1.23–1.56), p < 0.0001], SGA [OR 3.48 (3.16–3.83), p < 0.0001], stillbirth [OR 2.42 (1.87–3.12), p < 0.0001], GDM [OR 1.82 (1.59– 2.07), p < 0.0001], PTD prior to 37 weeks gestation [OR 1.33 (1.23–1.44), p < 0.0001], and emergency CS [OR 2.42 (1.87– 3.12), p < 0.0001]. On the other hand, African women were less likely to develop LGA and OC [OR (95% CI): 0.63 (0.58– 0.67) and 0.47 (0.32–0.69) respectively; p < 0.0001 for both]. Conclusion: Compared to Caucasian ethnic background, women of African origin have a different risk profile for adverse pregnancy outcomes. This difference should be taken into account when calculating an individualised adjusted risk or when tailoring antenatal care.
191
square = 39.11, p < .001) with gestational hypertension more common in Whites, chronic hypertension in African Americans, and mild preeclampsia in Hispanics. The overall incidence of preeclampsia was lower in Hispanics. However, severe preeclampsia rates were equal across groups. Hispanics were more likely to be uninsured, younger, enter prenatal care later, and least likely to complete high school. There was no significant difference in smoking or parity. Stratified analyses by ethnicity showed that the relationship between severe preeclampsia and comorbidities (IUGR, LBW, ICN admission) were least pronounced in Hispanics and strongest in African American women. Conclusion: Despite similar rates of severe preeclampsia and adverse sociodemographic characteristics, Hispanic women with severe preeclampsia had better pregnancy outcomes than African–American or White women with the disease.
Disclosure of interest None declared.
Disclosure of interest
doi:10.1016/j.preghy.2012.04.029
None declared. doi:10.1016/j.preghy.2012.04.028
OS028. Hypertensive disease in pregnancy: An examination of ethnic differences and the Hispanic paradox M. Small 1,*, A. Carr 2, T. Kershaw 3, H. Brown 4 (1 Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, United States, 2 Obstetrics and Gynecology, Associates for Women’s Healthcare, Louisville, United States, 3 Epidmiology and Public Health, Yale University School of Public Health, New Haven, United States, 4 Obstetrics and Gynecology, Duke University School of Medicine, Durham, United States) Introduction: The ‘‘Hispanic Paradox’’ refers to the epidemiological finding that Hispanics in the US have better health outcomes than the average population despite what their aggregate socioeconomic determinants would predict. Objectives: The aim of this study was to evaluate obstetric outcomes for a multiethnic population with hypertensive diseases. Methods: We performed a retrospective review of parturients with hypertensive disease delivering at Duke University Medical Center in 2005–2007. We analyzed maternal sociodemographic characteristics and ethnic differences in hypertensive disease types using Chi Square. We assessed the role of race and ethnicity on maternal and neonatal outcomes through a series of logistic regression analyses. Results: Nine thousand eight hundred and thirteen women delivered during the study period, and 9% had hypertensive diseases in pregnancy. There were significant racial and ethnic differences in presentation (Chi-
OS029. Severe anemia, sickle cell disease, and thalassemia as risk factors for preeclampsia in developing countries J.J. Zhang 1,*, J. Grewal 2, M. Roosen-Runge 2, A.P. Betran Lazaga 3, J.P. Souza 3, M. Widmer 3, M. Merialdi 3 (1 Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 2 NICHD, NIH, Bethesda, United States, 3 Reproductive Health and Research, WHO, Geneva, Switzerland) Introduction: Hypertensive disorders during pregnancy contribute greatly to maternal and perinatal morbidity and mortality in developing countries. The pathogenesis of such conditions may be illuminated by exploring their relationship to anemia. Objectives: To determine whether several types of anemia are risk factors for hypertensive disorders during pregnancy in developing countries. Methods: Using data from the World Health Organization Global Survey for Maternal and Perinatal Health, collected in hospitals in six African and six Latin American countries from 2007 to 2008 and in four Asian countries from 2004 to 2005, we examined the associations between severe anemia, sickle cell disease and thalassemia and gestational hypertension or preeclampsia/eclampsia. After exclusions for comorbidities (chronic hypertension, diabetes, HIV infection) and missing data, the severe anemia, sickle cell disease, and thalassemia groups consisted of 219,627, 117,383, and 9376 women, respectively. Results: Multiparous women with severe anemia were at an increased risk of gestational hypertension (adjusted odds ratio (OR): 1.58; 95% confidence interval (CI): 1.15–2.19). Severe anemia had a significant association with preeclampsia/eclampsia for nulliparous (OR: 3.55; 95% CI: 2.87–4.41) and multiparous (OR: 3.94; 95% CI: 3.05–5.09) women.
192
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239
Sickle cell disease exhibited a significant association with gestational hypertension among nulliparous (OR: 2.49; 95% CI: 1.46–4.25) and multiparous (OR: 3.27; 95% CI: 2.33– 4.58) women. No significant associations were found between sickle cell disease and preeclampsia/eclampsia, or between thalassemia and either gestational hypertension or preeclampsia/eclampsia. Conclusion: Severe anemia appears to be a risk factor for preeclampsia/eclampsia, while sickle cell disease appears to be a risk factor for gestational hypertension among women seeking hospital care in developing countries.
Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.030
OS030. Hypertension and labor duration: Does it take longer? J.M. Bregand-White *, M. Kominiarek, J.U. Hibbard Consortium on Safe Labor (Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, United States) Introduction: Hypertensive disease in pregnancy carries higher maternal and fetal morbidity and mortality and often requires labor induction to minimize risk. It was previously taught that preeclampsia was associated with a more rapid progression through all stages of labor, while there is a paucity of data in other hypertensive categories. One investigation in preeclamptic women demonstrated that labor progress was prolonged with increased risk for cesarean delivery. Objectives: To study labor progression in induced nulliparas at term with hypertensive diseases in pregnancy. Methods: Retrospective cohort study using data from the Consortium on Safe Labor; a multicenter project that abstracted labor and delivery information from electronic medical records in 19 hospitals across the US. A total of 32,276 women with singleton term gestation, induced labor, and vertex presentation were studied. Hypertensive women were grouped into 4 separate categories: chronic
hypertension (cHTN), gestational hypertension (gHTN), preeclampsia (PreE) and superimposed preeclampsia (SIPreE) and compared to controls (no hypertensive disorder). For the first stage of labor, Interval-censored regression analysis was used to estimate median and 95th % duration of labor, centimeter by centimeter and from 4– 10 cm. Results: Significant differences were noted in demographics between each group and controls including age, race, labor admission body mass index, gestational age at delivery, comorbidities, and admission cervical dilation (P < 0.01 for all comparisons to the control group). As noted in the table, women with cHTN and SIPreE had a longer first stage of labor, gHTN had a shorter first stage of labor, and labor length was similar in PreE compared to controls. Second stage of labor was longer (5–41 min) with epidural and varied among groups; however, the clinical significance is limited. 95th% for progression from 4–10 cm in cHTN, SIPreE and gHTN were 27.4, 28.2 and 16.5 h respectively (controls 20.1 h). Conclusion: In nulliparas induced at term with hypertensive disease, labor progression in the first and second stage varies from controls. gHTN women have the shortest first stage of labor while PreE gravidas have labor patterns similar to controls. As cHTN and SIPreE women have a longer first stage, allowing labor to continue for a longer period in these gravidas may contribute to a reduced rate of cesarean delivery in the US, but will require further investigation.
Disclosure of interest None declared doi:10.1016/j.preghy.2012.04.031
OS031. Lifestyle intervention after complicated pregnancy successfully improves cardiovascular and metabolic health: Results of the pro-active study D. Berks 1,*, M. Hoedjes 2, A. Franx 3, H.J. Duvekot 1, H. Raat 2, E.A. Steegers 1 (1 Obstetrics and Gynecology, UMCU, Utrecht, Netherlands, 2 Public Health, Erasmus MC, Rotterdam,