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P356 Does coffee intake during pregnancy prevent gestational diabetes mellitus?
S516
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
colitis in pregnancy, while rare, is usually associated with high circulating estrogen levels. A case of ischemic colitis following haemorrhage at the time of caesarean section (C/S) is presented. P355 Pheochromocytoma and pregnancy: Complications and solutions – Case report M. Nemsadze1 , Z. Sinauridze. 1 O.Gudushauri National Medical Centre, 2 Background: Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. Methods: A patient with paroxysmal hypertension, postpartum intraabdominal bleeding, and a recognized pheochromocytoma is described. Clinical features: A 36-yr-old previously practical healthy woman (gravida 4, para 3) presented to our tertiary care centre at 26+4/7 weeks gestation with a history of labile blood pressure and severe hypertension. A two week prior to admission she began having episodes of severe headache, sweating, nausea and dizziness. On an obstetric visit she was noted to be severely hypertensive with a blood pressure of 220/120 mmHg. Ultrasound imaging demonstrated a 11.6×9.2 cm2 right adrenal mass, biochemical investigations confirmed the diagnosis of pheochromocytoma. The patient was monitored in the ICU and treated with alphablockers and doxazosin. A multidisciplinary conference was organized involving endocrinology, anesthesiology, general surgery and obstetrics to determine the most appropriate management of the patient. Childbirth was performed by Cesarean Section with simultaneous right-sided adrenalectomy. Postoperative period was complicated with intraabdominal bleeding consequently treated during relaparatomy. Conclusions: The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, usage of alpha-blockers, and avoidance of a hypertensive crisis during delivery and definitive surgical treatment. Cesarean section is the preferred mode of delivery when the tumor is still present. Complications such is bleeding from adrenalectomy site should be considered. P356 Does coffee intake during pregnancy prevent gestational diabetes mellitus? B. Nielsen1 , P. Ovesen1 , T. Henriksen2 . 1 Dept of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Denmark, 2 Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Denmark Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that arises during pregnancy and disappears after delivery. Recent studies suggest that intake of coffee or rather maybe caffeine is associated with a reduced risk of type 2 diabetes mellitus. In this study, we wish to study the effect of coffee consumption during early pregnancy on the risk of GDM. Material and Methods: All women scheduled to deliver in our Hospital from 1 January 2004 to 31 March 2007 have been invited to complete two self-administered questionnaires during pregnancy. There was a response rate of 91%. The potential confounding factors; parity, age, BMI, smoking, alcohol intake and employment were also collected by the pregnancy questionnaires. Data were analyzed using logistic regression analyses with coffee as primary exposure and GDM as the outcome while adjusting for all the potential confounding factors in multivariate models. Results: 12,138 women were included in the study. 1.6% developed GDM during pregnancy. Upper quartile of reported coffee consumption per week was 1 cup per day. In the final logistic regression model coffee drinking during pregnancy was associated
with 27% decreased risk of GDM when controlled for relevant confounding factors OR (CI 95%) 0.73 (0.51 – 1.03). Conclusion: The number of women who developed GDM during pregnancy was lower than expected. This may be due to less intensive screening procedures prior to 2005. Coffee drinking during pregnancy was associated with an approximately 25% decrease in the risk of GDM when controlled for relevant confounding factors. P357 Perinatal and maternal outcomes in pregnant women with sickle cell disease and sickle cell trait K. Tosta1 , R. Nomura1 , A. Igai1 , G. Fonseca2 , S. Gualandro2 , M. Zugaib1 . 1 Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo, 2 Department of Hematology, Faculty of Medicine, University of S˜ ao Paulo Objectives: The aim of this study was to describe perinatal and maternal outcomes in pregnant women with sickle cell disease (SCD) and sickle cell trait (SCT). Methods: This was a retrospective cohort (2001–2007). Perinatal and maternal outcomes for Brazilian pregnant women with SCD were compared with those with SCT. SCD-SS was diagnosed in the 42 pregnancies, and SC in 9 and SCT was present in 56. Results: Maternal age was significantly lower in SCD group (mean = 26.0years, SD = 4.3years) when compared to SCT women (mean = 28.7years, SD = 7.1years, p = 0.018) Maternal complications were more common among women with SCD when compared to SCT: antepartum hospital admissions (52.9% vs. 21.4%, p = 0.002), urinary infection (25.5% vs. 8.9%, p = 0.043), hepatitis (21.3% vs. 5.4%, p = 0.03), pneumonia (23.5% vs. 1.8%, p = 0.002), maternal cardiac dysfunction (31.4% vs. 3.6%, p < 0.001), pulmonary hypertension (15.7% vs. 0%, p = 0.002), mean white blood cell count (15.7x109/L vs. 9.5x109/L, p < 0.0001), platelet count above 300,000/mm3 (77.8% vs. 18.2%, p < 0.0001) and complications at delivery (17.6% vs. 1.8%, p = 0.007). Perinatal outcome was significantly abnormal in the group of SCD when compared to SCT, respectively: prematurity (GA at delivery <37wks: 49% vs. 25%, p = 0.017), mean gestational age at delivery (35.2weeks vs. 37.9weeks, p = 0.0002), fetal distress (56.9% vs. 28.6%, p = 0.006), birth weight <2,500 g (62.7% vs. 17.9%, p < 0.0001), mean birth weight (2,182 g vs. 2922 g, p < 0.0001) and small for gestational age infant (49.0% vs. 23.2%, p = 0.01). Conclusion: Women with sickle cell disease are at greater risk for maternal morbidity and for adverse perinatal outcome than sickle cell trait. P358 Low Apgar’s score at first minute and maternal platelet count in pregnancies complicated by sickle cell disease R. Nomura1 , A. Igai1 , K. Tosta1 , G. Fonseca2 , S. Gualandro2 , M. Zugaib1 . 1 Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo, 2 Department of Hematology, Faculty of Medicine, University of S˜ ao Paulo Objective: The aim of this study was to compare maternal antenatal factors associated with low Apgar’s score at first minute in singleton pregnancies complicated by sickle cell disease (SCD). Methods: This was a retrospective cohort study using data prospectively collected from 2001 to 2007. Sickle cell disease (SS) was the hemoglobinopathy diagnosed in the 37 pregnancies and sickle hemoglobin C disease (SC) in eight pregnancies. This study was based on prenatal records, hospital admissions and a data base of deliveries at 20 weeks’ gestation or more. Cases of fetal death were excluded. Spontaneous abortions were not included in this study. Data analysis included Mann-Whitney U test and Fisher’s exact test. Statistical significance was defined as p < 0.05. Results: Maternal platelet count before delivery was significantly lower in the group with 1st min Apgar’s score <7 (mean = 299.1×109 /L, minimum = 116×109 /L, maximum = 642×109 /L) when
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
colitis in pregnancy, while rare, is usually associated with high circulating estrogen levels. A case of ischemic colitis following haemorrhage at the time of caesarean section (C/S) is presented. P355 Pheochromocytoma and pregnancy: Complications and solutions – Case report M. Nemsadze1 , Z. Sinauridze. 1 O.Gudushauri National Medical Centre, 2 Background: Hypertension is the most common medical complication of pregnancy. Pheochromocytoma in pregnancy is rare, and if unrecognized, can cause serious perinatal morbidity and mortality. Methods: A patient with paroxysmal hypertension, postpartum intraabdominal bleeding, and a recognized pheochromocytoma is described. Clinical features: A 36-yr-old previously practical healthy woman (gravida 4, para 3) presented to our tertiary care centre at 26+4/7 weeks gestation with a history of labile blood pressure and severe hypertension. A two week prior to admission she began having episodes of severe headache, sweating, nausea and dizziness. On an obstetric visit she was noted to be severely hypertensive with a blood pressure of 220/120 mmHg. Ultrasound imaging demonstrated a 11.6×9.2 cm2 right adrenal mass, biochemical investigations confirmed the diagnosis of pheochromocytoma. The patient was monitored in the ICU and treated with alphablockers and doxazosin. A multidisciplinary conference was organized involving endocrinology, anesthesiology, general surgery and obstetrics to determine the most appropriate management of the patient. Childbirth was performed by Cesarean Section with simultaneous right-sided adrenalectomy. Postoperative period was complicated with intraabdominal bleeding consequently treated during relaparatomy. Conclusions: The primary goals in the management of pheochromocytoma in pregnancy are early diagnosis, usage of alpha-blockers, and avoidance of a hypertensive crisis during delivery and definitive surgical treatment. Cesarean section is the preferred mode of delivery when the tumor is still present. Complications such is bleeding from adrenalectomy site should be considered. P356 Does coffee intake during pregnancy prevent gestational diabetes mellitus? B. Nielsen1 , P. Ovesen1 , T. Henriksen2 . 1 Dept of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Denmark, 2 Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Denmark Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that arises during pregnancy and disappears after delivery. Recent studies suggest that intake of coffee or rather maybe caffeine is associated with a reduced risk of type 2 diabetes mellitus. In this study, we wish to study the effect of coffee consumption during early pregnancy on the risk of GDM. Material and Methods: All women scheduled to deliver in our Hospital from 1 January 2004 to 31 March 2007 have been invited to complete two self-administered questionnaires during pregnancy. There was a response rate of 91%. The potential confounding factors; parity, age, BMI, smoking, alcohol intake and employment were also collected by the pregnancy questionnaires. Data were analyzed using logistic regression analyses with coffee as primary exposure and GDM as the outcome while adjusting for all the potential confounding factors in multivariate models. Results: 12,138 women were included in the study. 1.6% developed GDM during pregnancy. Upper quartile of reported coffee consumption per week was 1 cup per day. In the final logistic regression model coffee drinking during pregnancy was associated
with 27% decreased risk of GDM when controlled for relevant confounding factors OR (CI 95%) 0.73 (0.51 – 1.03). Conclusion: The number of women who developed GDM during pregnancy was lower than expected. This may be due to less intensive screening procedures prior to 2005. Coffee drinking during pregnancy was associated with an approximately 25% decrease in the risk of GDM when controlled for relevant confounding factors. P357 Perinatal and maternal outcomes in pregnant women with sickle cell disease and sickle cell trait K. Tosta1 , R. Nomura1 , A. Igai1 , G. Fonseca2 , S. Gualandro2 , M. Zugaib1 . 1 Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo, 2 Department of Hematology, Faculty of Medicine, University of S˜ ao Paulo Objectives: The aim of this study was to describe perinatal and maternal outcomes in pregnant women with sickle cell disease (SCD) and sickle cell trait (SCT). Methods: This was a retrospective cohort (2001–2007). Perinatal and maternal outcomes for Brazilian pregnant women with SCD were compared with those with SCT. SCD-SS was diagnosed in the 42 pregnancies, and SC in 9 and SCT was present in 56. Results: Maternal age was significantly lower in SCD group (mean = 26.0years, SD = 4.3years) when compared to SCT women (mean = 28.7years, SD = 7.1years, p = 0.018) Maternal complications were more common among women with SCD when compared to SCT: antepartum hospital admissions (52.9% vs. 21.4%, p = 0.002), urinary infection (25.5% vs. 8.9%, p = 0.043), hepatitis (21.3% vs. 5.4%, p = 0.03), pneumonia (23.5% vs. 1.8%, p = 0.002), maternal cardiac dysfunction (31.4% vs. 3.6%, p < 0.001), pulmonary hypertension (15.7% vs. 0%, p = 0.002), mean white blood cell count (15.7x109/L vs. 9.5x109/L, p < 0.0001), platelet count above 300,000/mm3 (77.8% vs. 18.2%, p < 0.0001) and complications at delivery (17.6% vs. 1.8%, p = 0.007). Perinatal outcome was significantly abnormal in the group of SCD when compared to SCT, respectively: prematurity (GA at delivery <37wks: 49% vs. 25%, p = 0.017), mean gestational age at delivery (35.2weeks vs. 37.9weeks, p = 0.0002), fetal distress (56.9% vs. 28.6%, p = 0.006), birth weight <2,500 g (62.7% vs. 17.9%, p < 0.0001), mean birth weight (2,182 g vs. 2922 g, p < 0.0001) and small for gestational age infant (49.0% vs. 23.2%, p = 0.01). Conclusion: Women with sickle cell disease are at greater risk for maternal morbidity and for adverse perinatal outcome than sickle cell trait. P358 Low Apgar’s score at first minute and maternal platelet count in pregnancies complicated by sickle cell disease R. Nomura1 , A. Igai1 , K. Tosta1 , G. Fonseca2 , S. Gualandro2 , M. Zugaib1 . 1 Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo, 2 Department of Hematology, Faculty of Medicine, University of S˜ ao Paulo Objective: The aim of this study was to compare maternal antenatal factors associated with low Apgar’s score at first minute in singleton pregnancies complicated by sickle cell disease (SCD). Methods: This was a retrospective cohort study using data prospectively collected from 2001 to 2007. Sickle cell disease (SS) was the hemoglobinopathy diagnosed in the 37 pregnancies and sickle hemoglobin C disease (SC) in eight pregnancies. This study was based on prenatal records, hospital admissions and a data base of deliveries at 20 weeks’ gestation or more. Cases of fetal death were excluded. Spontaneous abortions were not included in this study. Data analysis included Mann-Whitney U test and Fisher’s exact test. Statistical significance was defined as p < 0.05. Results: Maternal platelet count before delivery was significantly lower in the group with 1st min Apgar’s score <7 (mean = 299.1×109 /L, minimum = 116×109 /L, maximum = 642×109 /L) when