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PP026. Hyperuricemia in the prognosis of adverse perinatal outcomes
256
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Conclusion: Automated dipstick urinalysis is not more sensitive than visual read urinalysis for detection of proteinuria in a primarily outpatient setting in pregnancy. Both have excellent LR+ but only fair to poor LR as previously recognised for visual dipstick testing. Performance of automated strip analysis testing may vary with the test strips and analyser used.
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.136
PP026. Hyperuricemia in the prognosis of adverse perinatal outcomes C. Escudero 1,*, P. Bertoglia 2, J. Acurio 1, A. Escudero 1 (1 Basic Science Department, Universidad del Bio Bio, Chillan, Chile, 2 Obstetric and Gynecology, Hospital Clinico Herminda Martin, Chillan, Chile) Introduction: Elevated uric acid levels during the first or third trimester of gestation have been associated with poor perinatal outcomes in women with hypertensive pregnancies. Objectives: Investigate whether uric acid levels are related to adverse perinatal outcomes in Chilean hypertensive women. Methods: It is a post-hoc analysis from a retrospective study including clinical records (n = 416) of women with diagnosis of hypertension in pregnancy treated in the Hospi-
tal Clínico Herminda Martin, Chillán, Chile. From these records, 86 showed quantification of uric acid plasma levels at the moment of hypertension diagnosis (3 140/90 mmHg; at 34 ± 5 weeks). Women were divided into three groups, considering uric acid levels below 25th percentile (Low group, n = 27, <3.7 mg/dl), from 25th to 75th percentile (Middle group, n = 38, 3.8 to 5.7 mg/dl) and above 75th percentile (High group, n = 21, >5.8 mg/dl) for the studied population. Results: In the entire group of hypertensive women, the uric acid/creatinine ratio was positively related to hospitalization days (p = 0.04), and negatively associated with newborn weight (p = 0.02) and size (p = 0.01). ANOVA analysis did not show statistical differences in age, parity, systolic, diastolic or media blood pressure, body mass index, proteinuria, hepatic enzymes or hypoxia perinatal in women with low, middle or high uric acid levels. However, women with high uric acid levels showed a longer-hospitalization period (1.2 days more), less platelet count (40103/ml) and high creatinine plasma levels (0.2 mg/dl) and their babies showed less birth weight (800 g) and were smaller (3 cm) compared with women with low uric acid levels. Relative risk of intrauterine growth restriction in women with high levels of uric acid was 1.3 (CI, 0.96 to 1.73) compared with women with low levels. Conclusion: These data reinforce the general agreement about the utility of hyperuricemia in the prognosis of adverse perinatal outcomes in hypertensive pregnancies. Disclosure of interest: C. Escudero Grant/Research Support from: Fondecyt 1100684, P. Bertoglia: None declared, J. Acurio: None declared, A. Escudero: None declared.
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Acknowledgements Supported by FONDECYT 1100684, Conicyt Anillo ACT73. doi:10.1016/j.preghy.2012.04.137
PP027. Variation of urinary protein/creatinine ratio during the day in women suspected for preeclampsia K. Verdonk 1,*, W.C.J. Hop 2, Y.B. de Rijke 2, I.C. Niemeijer 2, E.A. Steegers 2, W. Visser 2 (1 Department of Internal Medicine Sector Pharmacology, Vascular and Metabolic Diseases, The Netherlands, 2 Department of Obstetrics and Gynecology, ErasmusMC, Rotterdam, The Netherlands) Introduction: Diagnosis of preeclampsia relies on protein quantification in a 24-hour urine collection, a procedure wrought with pitfalls and errors. There are growing claims that urine protein/creatinine ratios (PCR) on single voided urines are valid alternatives that should replace the timed collections, and decrease the time needed for decision making when triaging patients suspected to have preeclampsia. However the validity of such claims requires a demonstration that the ratio remains unchanged throughout the day (i.e. both creatinine and protein are excreted at a nearly constant rate), and this requirement does not appear to have been accurately studied nor evaluated. Objectives: This study is performed to study the correlation of PCR in single voided urine at different times of the day with 24-hour protein excretion. Furthermore we investigated the variation of PCR during the day. Methods: 105 patients, admitted to the Erasmus Medical Center to rule out preeclampsia underwent 24 hour urine collections with aliquots from 8.00 am, 12.00 and 5.00 pm void saved separately. Creatinine and protein levels were measured in each specimen along with the 24 hour collection whose volume was also recorded. Results: Figure shows the individual PCR data on 8.00 am, 12.00 and 5.00 pm. Each line represents an individual patient (N = 105). As shown in figure the variations of spot PCR as mg/mmol varied little the exceptions being women with high nephritic range proteinuria. Otherwise, the spot urinary PCR at all three times of the day correlated strongly with each other as well as with the 24-hour protein excretion. Receiver operating characteristics curves to discriminate between <0.3 and 0.3 g/24h of proteinuria have an area under the curve of respectively 0.94 (8.00 am), 0.96 (12.00) and 0.97 (5.00 pm). Sensitivity at a cutoff of 30 mg/mmol at 8.00 am, 12.00 and 5.00 pm were respectively 89%, 96% and 94%. Specificities at 8.00 am, 12.00 and 5.00 pm were respectively 75%, 78% and 78%. Conclusion: PCR in single voided urine, is a good alternative to the quantification of a 24-hour urine collection. Since it can obviously be obtained more rapidly than the day long collection it should lead to more rapid diagnosis and improved management. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.138
257
PP028. To assess maternal and neonatal outcomes of women on an antihypertensive agent with gestational hypertension, chronic hypertension or preeclampsia L. Holcomb, M.O. Cruz, J.U. Hibbard * (Obstetrics and Gynecology, University of Illinois Medical Center, Chicago, United States) Introduction: There is a lack of evidence regarding antihypertensive medicine use in pregnancy. Objectives: To compare maternal and neonatal outcomes of women on an antihypertensive agent with gestational hypertension (GHTN), chronic hypertension (CHTN) and preeclampsia (preE). Methods: The Consortium on Safe Labor electronic database from 19 hospitals across the US with 228,668 deliveries during 2002–2008 was used to extract data on gravidas with GHTN, CHTN, and preE on a calcium channel blocker, methyldopa, or beta blocker. Univariate and multivariate analyses were performed. Results: There were 637 women on beta blockers, 207 on calcium channel blockers, 249 on Methyldopa, and 6869 women with hypertension on no agent (control group). Women on beta blockers had an increased risk of ICU admission, OR 3.74 (95% CI 1.8-7.6). Risk of thrombosis was increased in women on beta blockers, OR 3.6 (95% CI 1.49.2) and calcium channel blockers, OR 10.6 (95% CI 3.829.2). There was no increased risk of small for gestational age babies. There was a small, increased risk of NICU admission for babies of women on calcium channel blockers, OR 1.7 (95% CI 1.2-2.6) and methyldopa, OR 1.9 (95% CI 1.42.7). Conclusion: Beta and calcium channel blocker use was associated with significant risks of morbidity compared to Methyldopa use by gravid women with hypertensive disease. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.139
PP029. Gestational hypertension and birth weight in twin pregnancies S. Ferrazzani *, S. Moresi, S. Garofalo, V.A. Degennaro, S. Salvi, E. Di Pasquo, G. Del Sordo, S. De Carolis (Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy) Introduction: It is well known that hypertensive disorders of pregnancy are most frequent in twin pregnancies than in singleton ones. As demonstrated by a previous work of our group, twin pregnancies complicated by preeclampsia are associated with a higher rate of ‘‘small for gestational age’’ (SGA) neonates and inter-twin weight discordance than normotensive ones. Objectives: The present study investigates the effect of gestational hypertension (GH) on neonatal birth weight, inter-twin weight discordance and growth restriction rate among twin pregnancies. Methods: A 26 year retrospective study was undertaken by examining 196 twin pregnancies complicated by GH,
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Conclusion: Automated dipstick urinalysis is not more sensitive than visual read urinalysis for detection of proteinuria in a primarily outpatient setting in pregnancy. Both have excellent LR+ but only fair to poor LR as previously recognised for visual dipstick testing. Performance of automated strip analysis testing may vary with the test strips and analyser used.
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.136
PP026. Hyperuricemia in the prognosis of adverse perinatal outcomes C. Escudero 1,*, P. Bertoglia 2, J. Acurio 1, A. Escudero 1 (1 Basic Science Department, Universidad del Bio Bio, Chillan, Chile, 2 Obstetric and Gynecology, Hospital Clinico Herminda Martin, Chillan, Chile) Introduction: Elevated uric acid levels during the first or third trimester of gestation have been associated with poor perinatal outcomes in women with hypertensive pregnancies. Objectives: Investigate whether uric acid levels are related to adverse perinatal outcomes in Chilean hypertensive women. Methods: It is a post-hoc analysis from a retrospective study including clinical records (n = 416) of women with diagnosis of hypertension in pregnancy treated in the Hospi-
tal Clínico Herminda Martin, Chillán, Chile. From these records, 86 showed quantification of uric acid plasma levels at the moment of hypertension diagnosis (3 140/90 mmHg; at 34 ± 5 weeks). Women were divided into three groups, considering uric acid levels below 25th percentile (Low group, n = 27, <3.7 mg/dl), from 25th to 75th percentile (Middle group, n = 38, 3.8 to 5.7 mg/dl) and above 75th percentile (High group, n = 21, >5.8 mg/dl) for the studied population. Results: In the entire group of hypertensive women, the uric acid/creatinine ratio was positively related to hospitalization days (p = 0.04), and negatively associated with newborn weight (p = 0.02) and size (p = 0.01). ANOVA analysis did not show statistical differences in age, parity, systolic, diastolic or media blood pressure, body mass index, proteinuria, hepatic enzymes or hypoxia perinatal in women with low, middle or high uric acid levels. However, women with high uric acid levels showed a longer-hospitalization period (1.2 days more), less platelet count (40103/ml) and high creatinine plasma levels (0.2 mg/dl) and their babies showed less birth weight (800 g) and were smaller (3 cm) compared with women with low uric acid levels. Relative risk of intrauterine growth restriction in women with high levels of uric acid was 1.3 (CI, 0.96 to 1.73) compared with women with low levels. Conclusion: These data reinforce the general agreement about the utility of hyperuricemia in the prognosis of adverse perinatal outcomes in hypertensive pregnancies. Disclosure of interest: C. Escudero Grant/Research Support from: Fondecyt 1100684, P. Bertoglia: None declared, J. Acurio: None declared, A. Escudero: None declared.
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Acknowledgements Supported by FONDECYT 1100684, Conicyt Anillo ACT73. doi:10.1016/j.preghy.2012.04.137
PP027. Variation of urinary protein/creatinine ratio during the day in women suspected for preeclampsia K. Verdonk 1,*, W.C.J. Hop 2, Y.B. de Rijke 2, I.C. Niemeijer 2, E.A. Steegers 2, W. Visser 2 (1 Department of Internal Medicine Sector Pharmacology, Vascular and Metabolic Diseases, The Netherlands, 2 Department of Obstetrics and Gynecology, ErasmusMC, Rotterdam, The Netherlands) Introduction: Diagnosis of preeclampsia relies on protein quantification in a 24-hour urine collection, a procedure wrought with pitfalls and errors. There are growing claims that urine protein/creatinine ratios (PCR) on single voided urines are valid alternatives that should replace the timed collections, and decrease the time needed for decision making when triaging patients suspected to have preeclampsia. However the validity of such claims requires a demonstration that the ratio remains unchanged throughout the day (i.e. both creatinine and protein are excreted at a nearly constant rate), and this requirement does not appear to have been accurately studied nor evaluated. Objectives: This study is performed to study the correlation of PCR in single voided urine at different times of the day with 24-hour protein excretion. Furthermore we investigated the variation of PCR during the day. Methods: 105 patients, admitted to the Erasmus Medical Center to rule out preeclampsia underwent 24 hour urine collections with aliquots from 8.00 am, 12.00 and 5.00 pm void saved separately. Creatinine and protein levels were measured in each specimen along with the 24 hour collection whose volume was also recorded. Results: Figure shows the individual PCR data on 8.00 am, 12.00 and 5.00 pm. Each line represents an individual patient (N = 105). As shown in figure the variations of spot PCR as mg/mmol varied little the exceptions being women with high nephritic range proteinuria. Otherwise, the spot urinary PCR at all three times of the day correlated strongly with each other as well as with the 24-hour protein excretion. Receiver operating characteristics curves to discriminate between <0.3 and 0.3 g/24h of proteinuria have an area under the curve of respectively 0.94 (8.00 am), 0.96 (12.00) and 0.97 (5.00 pm). Sensitivity at a cutoff of 30 mg/mmol at 8.00 am, 12.00 and 5.00 pm were respectively 89%, 96% and 94%. Specificities at 8.00 am, 12.00 and 5.00 pm were respectively 75%, 78% and 78%. Conclusion: PCR in single voided urine, is a good alternative to the quantification of a 24-hour urine collection. Since it can obviously be obtained more rapidly than the day long collection it should lead to more rapid diagnosis and improved management. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.138
257
PP028. To assess maternal and neonatal outcomes of women on an antihypertensive agent with gestational hypertension, chronic hypertension or preeclampsia L. Holcomb, M.O. Cruz, J.U. Hibbard * (Obstetrics and Gynecology, University of Illinois Medical Center, Chicago, United States) Introduction: There is a lack of evidence regarding antihypertensive medicine use in pregnancy. Objectives: To compare maternal and neonatal outcomes of women on an antihypertensive agent with gestational hypertension (GHTN), chronic hypertension (CHTN) and preeclampsia (preE). Methods: The Consortium on Safe Labor electronic database from 19 hospitals across the US with 228,668 deliveries during 2002–2008 was used to extract data on gravidas with GHTN, CHTN, and preE on a calcium channel blocker, methyldopa, or beta blocker. Univariate and multivariate analyses were performed. Results: There were 637 women on beta blockers, 207 on calcium channel blockers, 249 on Methyldopa, and 6869 women with hypertension on no agent (control group). Women on beta blockers had an increased risk of ICU admission, OR 3.74 (95% CI 1.8-7.6). Risk of thrombosis was increased in women on beta blockers, OR 3.6 (95% CI 1.49.2) and calcium channel blockers, OR 10.6 (95% CI 3.829.2). There was no increased risk of small for gestational age babies. There was a small, increased risk of NICU admission for babies of women on calcium channel blockers, OR 1.7 (95% CI 1.2-2.6) and methyldopa, OR 1.9 (95% CI 1.42.7). Conclusion: Beta and calcium channel blocker use was associated with significant risks of morbidity compared to Methyldopa use by gravid women with hypertensive disease. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.139
PP029. Gestational hypertension and birth weight in twin pregnancies S. Ferrazzani *, S. Moresi, S. Garofalo, V.A. Degennaro, S. Salvi, E. Di Pasquo, G. Del Sordo, S. De Carolis (Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy) Introduction: It is well known that hypertensive disorders of pregnancy are most frequent in twin pregnancies than in singleton ones. As demonstrated by a previous work of our group, twin pregnancies complicated by preeclampsia are associated with a higher rate of ‘‘small for gestational age’’ (SGA) neonates and inter-twin weight discordance than normotensive ones. Objectives: The present study investigates the effect of gestational hypertension (GH) on neonatal birth weight, inter-twin weight discordance and growth restriction rate among twin pregnancies. Methods: A 26 year retrospective study was undertaken by examining 196 twin pregnancies complicated by GH,