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PP170. Prenatal vitamin C and E supplementation is associated with a reduction in placental abruption and preterm birth in smokers
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
mia is considered severe when blood pressure 160/ 100 mHg, proteinuria 2g/l, bad neurosensorial signs, hemostasis disorders, kidney and liver failure, some fetal tests: delay intra-uterine growth acute fetal suffering, fetal death. Results: Frequency of severe toxemia 8, primiparous 58% vs. 35% control, gestational diabetes 12% vs. 10% control, oedema 87% vs. 45% control. Maternal morbidity is dominated by hemostasis disorders :low platelet count < 80,000 23% vs. 8%, hypofibrinogenemia <4 g/l 13% vs. 2%, HELLP syndrome eight cases vs. 0. We raised eight cases of eclampsia crises, 22 cases of retroplacental hematoma vs. 10 control. Blood transfusion 15% vs. 10% control, inhibitors of VII factor administered in two cases vs. 0. We do not deplore any maternal mortality. Fetal prognosis is very compromised ,the delay intra uterine growth 44% vs. 18% control, prematurity 66% vs. 15% control, perinatal mortality 60. vs 12 control Conclusion: More toxemia appears early during pregnancy more maternal and especially fetal prognosis is compromised. New drugs, predictive tests and preventives measurements improve maternal outcome better than fetals’ one. Disclosure of interest: None declared.
doi:10.1016/j.preghy.2012.04.280
331
PP170. Prenatal vitamin C and E supplementation is associated with a reduction in placental abruption and preterm birth in smokers R. Gandley 1,*, A. Abramovici 2, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network1 Environmental and Occupational Health, Magee Womens Research Institute & University of Pittsburgh, Pittsburgh, United States, 2 University of Alabama at Birmingham, Birmingham, United States) Introduction: Maternal tobacco use increases the incidence of numerous adverse pregnancy outcomes including miscarriage, small for gestational age infants, spontaneous preterm birth and placental abruption. Objectives: We evaluated the relationship between prenatal vitamin C/E supplementation and perinatal outcomes by maternal smoking status. Methods: Secondary analysis of a multicenter trial of vitamin C/E starting at 9–16 weeks in low-risk nulliparous women with singletons. We examined the effect of vitamin supplementation by reported smoker or non-smoker at time of randomization. The primary outcomes were preeclampsia (new onset hypertension and proteinuria) and a composite outcome of severe pregnancy associated hypertension (severe hypertension OR mild or severe hypertension with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclamptic seizure, fetal growth restriction, medically indicated preterm birth or perinatal death). Perinatal
332
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
outcomes included preterm birth and abruption. The Breslow-Day test was used to ascertain whether there was an interaction between smoking status and vitamin supplementation. Results: Of 9969 women, 4993 received vitamins C/E and 4976 received placebo. The prevalence of smoking (15.6% overall; 788 vitamin, 763 placebo) was similar in treatment groups. The analysis of vitamin C/E by smoking status for perinatal outcomes are given (Table 1). The effect of prenatal vitamin C/E on the risk preeclampsia or pregnancy associated hypertension composite outcome did not differ by smoking status. Vitamin C/E was protective for placental abruption and preterm birth among smokers. Conclusion: The effect of vitamin C/E supplementation on preeclampsia/pregnancy associated hypertension did not differ by smoking status. However, vitamin C/E supplementation was associated with a >40% reduction in placental abruption and >30% reduction in preterm birth among smokers warranting further study. Acknowledgement: This project supported in part by National Institutes of Health Grant PO1-HD30367.
Disclosure of interest: None declared.
doi:10.1016/j.preghy.2012.04.281
PP171. Hosptialized preterm mild preeclamptics: Is there a difference in outcomes between isolated or superimposed disease? D.F. Lewis 1,*, C. Armistead 1, A. Allison 1, Y. Wang 2 1 ( Department of OB GYN, University of South Alabama, Mobile, United States, 2 Department of OB GYN, LSU Health Sciences Center, Shreveport, United States) Introduction: Currently the standard of care is to admit and monitor patients with preterm mild preeclampsia. This is particularly important if the disease is superimposed in patients with chpt or with isolated disease if proteinuria is over 500 mg in 24 hours. Despite the common nature of this disease process little is known about the outcomes of these two groups.
mia is considered severe when blood pressure 160/ 100 mHg, proteinuria 2g/l, bad neurosensorial signs, hemostasis disorders, kidney and liver failure, some fetal tests: delay intra-uterine growth acute fetal suffering, fetal death. Results: Frequency of severe toxemia 8, primiparous 58% vs. 35% control, gestational diabetes 12% vs. 10% control, oedema 87% vs. 45% control. Maternal morbidity is dominated by hemostasis disorders :low platelet count < 80,000 23% vs. 8%, hypofibrinogenemia <4 g/l 13% vs. 2%, HELLP syndrome eight cases vs. 0. We raised eight cases of eclampsia crises, 22 cases of retroplacental hematoma vs. 10 control. Blood transfusion 15% vs. 10% control, inhibitors of VII factor administered in two cases vs. 0. We do not deplore any maternal mortality. Fetal prognosis is very compromised ,the delay intra uterine growth 44% vs. 18% control, prematurity 66% vs. 15% control, perinatal mortality 60. vs 12 control Conclusion: More toxemia appears early during pregnancy more maternal and especially fetal prognosis is compromised. New drugs, predictive tests and preventives measurements improve maternal outcome better than fetals’ one. Disclosure of interest: None declared.
doi:10.1016/j.preghy.2012.04.280
331
PP170. Prenatal vitamin C and E supplementation is associated with a reduction in placental abruption and preterm birth in smokers R. Gandley 1,*, A. Abramovici 2, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network1 Environmental and Occupational Health, Magee Womens Research Institute & University of Pittsburgh, Pittsburgh, United States, 2 University of Alabama at Birmingham, Birmingham, United States) Introduction: Maternal tobacco use increases the incidence of numerous adverse pregnancy outcomes including miscarriage, small for gestational age infants, spontaneous preterm birth and placental abruption. Objectives: We evaluated the relationship between prenatal vitamin C/E supplementation and perinatal outcomes by maternal smoking status. Methods: Secondary analysis of a multicenter trial of vitamin C/E starting at 9–16 weeks in low-risk nulliparous women with singletons. We examined the effect of vitamin supplementation by reported smoker or non-smoker at time of randomization. The primary outcomes were preeclampsia (new onset hypertension and proteinuria) and a composite outcome of severe pregnancy associated hypertension (severe hypertension OR mild or severe hypertension with elevated liver enzymes, elevated serum creatinine, thrombocytopenia, eclamptic seizure, fetal growth restriction, medically indicated preterm birth or perinatal death). Perinatal
332
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
outcomes included preterm birth and abruption. The Breslow-Day test was used to ascertain whether there was an interaction between smoking status and vitamin supplementation. Results: Of 9969 women, 4993 received vitamins C/E and 4976 received placebo. The prevalence of smoking (15.6% overall; 788 vitamin, 763 placebo) was similar in treatment groups. The analysis of vitamin C/E by smoking status for perinatal outcomes are given (Table 1). The effect of prenatal vitamin C/E on the risk preeclampsia or pregnancy associated hypertension composite outcome did not differ by smoking status. Vitamin C/E was protective for placental abruption and preterm birth among smokers. Conclusion: The effect of vitamin C/E supplementation on preeclampsia/pregnancy associated hypertension did not differ by smoking status. However, vitamin C/E supplementation was associated with a >40% reduction in placental abruption and >30% reduction in preterm birth among smokers warranting further study. Acknowledgement: This project supported in part by National Institutes of Health Grant PO1-HD30367.
Disclosure of interest: None declared.
doi:10.1016/j.preghy.2012.04.281
PP171. Hosptialized preterm mild preeclamptics: Is there a difference in outcomes between isolated or superimposed disease? D.F. Lewis 1,*, C. Armistead 1, A. Allison 1, Y. Wang 2 1 ( Department of OB GYN, University of South Alabama, Mobile, United States, 2 Department of OB GYN, LSU Health Sciences Center, Shreveport, United States) Introduction: Currently the standard of care is to admit and monitor patients with preterm mild preeclampsia. This is particularly important if the disease is superimposed in patients with chpt or with isolated disease if proteinuria is over 500 mg in 24 hours. Despite the common nature of this disease process little is known about the outcomes of these two groups.