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PP094. A comparison of gestational changes in urinary excretion of magnesium with those of calcium
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Methods: The study included a total of 70 delivered pregnancies. The study group included 14 oocyte donor IVF-ET (d-IVF-ET) from women aged 32–52 years. The results from the study group were compared to the next two consecutive deliveries from the autologous IVF-ET (IVF-ET group) (n = 28; age 30–46 years) and with two more consecutive deliveries from women older than 40 years (Advanced Maternal Age: AMA) (n = 28, age 40–45 years). We evaluated the occurrence of pregnancy-induced hypertension (PIH), preeclampsia (PE), fetal growth restriction (IUGR), the gestational age at birth, placental anomalies, the mode of delivery, birth weight and the neonatal Apgar score. The fetal weight was corrected with the gestational age at the time of delivery according to Gardosi. Statistical analysis was performed with the Chi-squared test. Results: Oocyte donor pregnancies had significantly higher rates of PE (d-IVF-ET 21.4%, IVF-ET 0%, AMA 0%, p < 0.011). They also had higher rates of PIH and IUGR (dIVF-ET 21.4%, IVF-ET 0%, AMA 3.6% p < 0.011) (d- IVF-ET 21.4%, IVF-ET 7.1%, AMA 3.6% p < 0.011 respectively). We found placental anomalies only in the d-IVF-ET group; the incidence of placental accretism was 28.6%, (p < 0.003). There are not significant differences in the gestational age at birth, placental anomalies, the mode of delivery, birth weight and the neonatal Apgar score between the groups. Conclusion: This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of autologous IVF-ET pregnancies and to advanced maternal age. The advanced maternal age criterion assumes that most women requiring oocyte donation are older. Hypertensive disorders were surprisingly not related to maternal age or to the in vitro fertilization technique. Obstetricians that deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accrete and pregnancy-related hypertensive disorders. This warrants close blood pressure monitoring and an accurate placenta ultrasound. All women who conceive through oocyte donation should be counselled as early as the pre-conception period and referred to specific centres for high-risk pregnancies. Disclosure of interest: None declared doi:10.1016/j.preghy.2012.04.204
PP094. A comparison of gestational changes in urinary excretion of magnesium with those of calcium M. Yamasaki 1,*, N. Makihara 2, R. Hazama 2, H. Morita 2, H. Yamada 2 (1 Department of Community Medicine and Social Healthcare Science, Kobe, Japan, 2 Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan) Introduction: Magnesium is one of the essential minerals required in various cellular functions. Some investigators have postulated that some aspects of pathophysiology in preeclampsia could be associated with alteration in regulatory mechanisms of the mineral. However, gestational changes in absorption, excretion and blood concentration
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of magnesium have remained less elucidated compared with those of calcium, which is another important mineral forming a divalent cation. Objectives: The purpose of this study was to clarify if urinary excretion of magnesium during pregnancy might be altered compared with those of calcium. Methods: Sixty specimens of 24 h urine and 586 samples of spot urine were collected from healthy pregnant women who gave consent. Determination of the minerals were according to Orthocresol-phthalein complexone method for calcium, and xylidyl blue method for magnesium. Urinary creatinine was determined by Jaffe Method. Results: Daily excretions of magnesium determined with 24 h samples were 60, 70, 81, 65, and 102 mg in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. There were no statistical differences among the values. Those of calcium were 174, 186, 139, 52, and 40 mg, respectively. The values in term and in postpartum were significantly lower than those in 1st through early 3rd trimesters. The Mg/Cr ratios (mg/mg Cr) determined with spot urine samples were 0.064, 0.071, 0.066, 0.067, and 0.086, in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. The value of Mg/Cr in postpartum was significantly higher than the values in pregnant period. The Ca/ Cr ratios (mg/mg Cr) were 0.164, 0.163, 0.135, 0.118, and 0.090, respectively. There was a trend of decreasing pattern in changes of Ca/Cr from 2nd trimester to postpartum. Conclusion: It is suggested that there is a mechanism of preservation of calcium in the late phase of pregnancy or puerperal period by reducing urinary excretion of the mineral. However, human pregnancy does not seem to show such a function controlling magnesium metabolism. Disclosure of interest: M. Yamasaki: None, N. Makihara: None, R. Hazama: None, H. Morita: None, H. Yamada: None
doi:10.1016/j.preghy.2012.04.205
PP095. Guideline-based development of quality indicators for hypertensive diseases in pregnancy S. Luitjes 1,2,*, M. Wouters 2, A. Franx 3, A. Bolte 2, C. de Groot 2, M. van Tulder 1,4, R. Hermens 5 (1 EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands, 2 Obstetrics and Gynaecology, Vrije University Medical Centre Amsterdam, Amsterdam, Netherlands, 3 Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands, 4 Department of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands, 5 Scientific Institute for Quality of Health Care (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands) Introduction: Hypertensive disorders in pregnancy are one of the main causes of maternal morbidity and mortality. Internationally, several organizations have developed clinical guidelines to assist professionals and to supply patients with the best possible care. To improve the care for this
Methods: The study included a total of 70 delivered pregnancies. The study group included 14 oocyte donor IVF-ET (d-IVF-ET) from women aged 32–52 years. The results from the study group were compared to the next two consecutive deliveries from the autologous IVF-ET (IVF-ET group) (n = 28; age 30–46 years) and with two more consecutive deliveries from women older than 40 years (Advanced Maternal Age: AMA) (n = 28, age 40–45 years). We evaluated the occurrence of pregnancy-induced hypertension (PIH), preeclampsia (PE), fetal growth restriction (IUGR), the gestational age at birth, placental anomalies, the mode of delivery, birth weight and the neonatal Apgar score. The fetal weight was corrected with the gestational age at the time of delivery according to Gardosi. Statistical analysis was performed with the Chi-squared test. Results: Oocyte donor pregnancies had significantly higher rates of PE (d-IVF-ET 21.4%, IVF-ET 0%, AMA 0%, p < 0.011). They also had higher rates of PIH and IUGR (dIVF-ET 21.4%, IVF-ET 0%, AMA 3.6% p < 0.011) (d- IVF-ET 21.4%, IVF-ET 7.1%, AMA 3.6% p < 0.011 respectively). We found placental anomalies only in the d-IVF-ET group; the incidence of placental accretism was 28.6%, (p < 0.003). There are not significant differences in the gestational age at birth, placental anomalies, the mode of delivery, birth weight and the neonatal Apgar score between the groups. Conclusion: This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of autologous IVF-ET pregnancies and to advanced maternal age. The advanced maternal age criterion assumes that most women requiring oocyte donation are older. Hypertensive disorders were surprisingly not related to maternal age or to the in vitro fertilization technique. Obstetricians that deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accrete and pregnancy-related hypertensive disorders. This warrants close blood pressure monitoring and an accurate placenta ultrasound. All women who conceive through oocyte donation should be counselled as early as the pre-conception period and referred to specific centres for high-risk pregnancies. Disclosure of interest: None declared doi:10.1016/j.preghy.2012.04.204
PP094. A comparison of gestational changes in urinary excretion of magnesium with those of calcium M. Yamasaki 1,*, N. Makihara 2, R. Hazama 2, H. Morita 2, H. Yamada 2 (1 Department of Community Medicine and Social Healthcare Science, Kobe, Japan, 2 Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan) Introduction: Magnesium is one of the essential minerals required in various cellular functions. Some investigators have postulated that some aspects of pathophysiology in preeclampsia could be associated with alteration in regulatory mechanisms of the mineral. However, gestational changes in absorption, excretion and blood concentration
291
of magnesium have remained less elucidated compared with those of calcium, which is another important mineral forming a divalent cation. Objectives: The purpose of this study was to clarify if urinary excretion of magnesium during pregnancy might be altered compared with those of calcium. Methods: Sixty specimens of 24 h urine and 586 samples of spot urine were collected from healthy pregnant women who gave consent. Determination of the minerals were according to Orthocresol-phthalein complexone method for calcium, and xylidyl blue method for magnesium. Urinary creatinine was determined by Jaffe Method. Results: Daily excretions of magnesium determined with 24 h samples were 60, 70, 81, 65, and 102 mg in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. There were no statistical differences among the values. Those of calcium were 174, 186, 139, 52, and 40 mg, respectively. The values in term and in postpartum were significantly lower than those in 1st through early 3rd trimesters. The Mg/Cr ratios (mg/mg Cr) determined with spot urine samples were 0.064, 0.071, 0.066, 0.067, and 0.086, in 1st, 2nd, and early 3rd trimesters, term, and postpartum 4weeks, respectively. The value of Mg/Cr in postpartum was significantly higher than the values in pregnant period. The Ca/ Cr ratios (mg/mg Cr) were 0.164, 0.163, 0.135, 0.118, and 0.090, respectively. There was a trend of decreasing pattern in changes of Ca/Cr from 2nd trimester to postpartum. Conclusion: It is suggested that there is a mechanism of preservation of calcium in the late phase of pregnancy or puerperal period by reducing urinary excretion of the mineral. However, human pregnancy does not seem to show such a function controlling magnesium metabolism. Disclosure of interest: M. Yamasaki: None, N. Makihara: None, R. Hazama: None, H. Morita: None, H. Yamada: None
doi:10.1016/j.preghy.2012.04.205
PP095. Guideline-based development of quality indicators for hypertensive diseases in pregnancy S. Luitjes 1,2,*, M. Wouters 2, A. Franx 3, A. Bolte 2, C. de Groot 2, M. van Tulder 1,4, R. Hermens 5 (1 EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands, 2 Obstetrics and Gynaecology, Vrije University Medical Centre Amsterdam, Amsterdam, Netherlands, 3 Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands, 4 Department of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands, 5 Scientific Institute for Quality of Health Care (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands) Introduction: Hypertensive disorders in pregnancy are one of the main causes of maternal morbidity and mortality. Internationally, several organizations have developed clinical guidelines to assist professionals and to supply patients with the best possible care. To improve the care for this