Obstetrics

KEYSTONE, COLO. — The explanation for pregnancy as a risk factor for severe pandemic 2009 H1N1 influenza infection may lie in a newly described association between the severity of H1N1 disease and the presence of IgG2 subclass deficiency.

This finding by Australian investigators, if confirmed, may not only shed new light on the pathogenesis of severe H1N1 infection but also prove to have important therapeutic implications, Dr. Gwen Huitt observed at a meeting on allergy and respiratory diseases.

Early in the pandemic, pregnant women were identified as one of the groups at particularly high risk for severe infection requiring ICU admission. Other high-risk groups included children less than 2 years of age, the obese, and individuals with chronic lung, heart, or kidney disease. The mechanisms underlying this increased risk have been unclear, said Dr. Huitt, professor of medicine at the University of Colorado and director of the adult infectious disease care unit at National Jewish Health, both in Denver.

Investigators in Melbourne decided to assess total IgG and IgG subclasses in a consecutive series of patients requiring ICU admission for pandemic flu. The impetus for their study came when they noted IgG2 subclass deficiency in a pregnant woman admitted to the ICU for severe H1N1 disease.

The study population consisted of 39 patients hospitalized for H1N1 infection and 17 healthy pregnant controls. A total of 19 patients had severe infection, meaning they required mechanical ventilation and ICU admission. Twenty others had moderate H1N1 disease, defined by hospitalization without ICU care. A total of 7 of the 19 patients with severe infection were pregnant, as were 2 of 20 with moderate infection.

Fifteen of the 19 patients with severe H1N1 infection had low IgG2, with a mean value of 1.8 g/L, as did 5 of the 20 with moderate infection. Furthermore, 10 of the 17 healthy pregnant controls had mildly low IgG2, although their diminished levels were nonetheless significantly higher than those of the pregnant women hospitalized for H1N1 infection.

Severe H1N1 infection was also associated with low total IgG, anemia, and hypoalbuminemia, although multivariate analysis revealed that the associations were significant only for low mean IgG2 and hypoalbuminemia.

Follow-up of 15 surviving H1N1-infected, IgG2-deficient patients showed that 11 remained IgG2-deficient at 90 days, well after recovery from their acute disease episode. In contrast, hypoalbuminemia typically resolved within 30 days (Clin. Infect. Dis. 2010;50:672-8).

The investigators argued that long-term follow-up may be warranted in patients sick enough to require hospitalization for H1N1 infection, since the late implications of lingering IgG2 deficiency in this population are unclear. For example, it is not known whether such patients will have a diminished immunologic response to influenza vaccination.

In terms of the potential therapeutic implications of the Australian findings, the investigators noted that administration of convalescent blood products during the 1918 H1N1 flu pandemic resulted in a survival benefit. Inspired by that experience, the Australians have given pooled immunoglobulins to several IgG2-deficient patients with severe H1N1 infection, although they are unclear whether the immunoglobulins had an effect because they weren't given under a study protocol.

Dr. Huitt said the Australian study raises an intriguing hypothesis: “The question is, was this virus selective in choosing those who may be living with a slightly low IgG2, and then overwhelming the immune system's ability to fight the cascade induced by that infection?

“This is something that needs a lot more work,” Dr. Huitt said at the meeting, which was sponsored by the National Jewish Medical and Research Center.

IgG2 subclass deficiency is typically asymptomatic.

Disclosures: The study was funded by the National Health and Medical Research Council of Australia. Dr. Huitt reported having no relevant financial conflicts.

KEYSTONE, COLO. — The explanation for pregnancy as a risk factor for severe pandemic 2009 H1N1 influenza infection may lie in a newly described association between the severity of H1N1 disease and the presence of IgG2 subclass deficiency.

This finding by Australian investigators, if confirmed, may not only shed new light on the pathogenesis of severe H1N1 infection but also prove to have important therapeutic implications, Dr. Gwen Huitt observed at a meeting on allergy and respiratory diseases.

Early in the pandemic, pregnant women were identified as one of the groups at particularly high risk for severe infection requiring ICU admission. Other high-risk groups included children less than 2 years of age, the obese, and individuals with chronic lung, heart, or kidney disease. The mechanisms underlying this increased risk have been unclear, said Dr. Huitt, professor of medicine at the University of Colorado and director of the adult infectious disease care unit at National Jewish Health, both in Denver.

Investigators in Melbourne decided to assess total IgG and IgG subclasses in a consecutive series of patients requiring ICU admission for pandemic flu. The impetus for their study came when they noted IgG2 subclass deficiency in a pregnant woman admitted to the ICU for severe H1N1 disease.

The study population consisted of 39 patients hospitalized for H1N1 infection and 17 healthy pregnant controls. A total of 19 patients had severe infection, meaning they required mechanical ventilation and ICU admission. Twenty others had moderate H1N1 disease, defined by hospitalization without ICU care. A total of 7 of the 19 patients with severe infection were pregnant, as were 2 of 20 with moderate infection.

Fifteen of the 19 patients with severe H1N1 infection had low IgG2, with a mean value of 1.8 g/L, as did 5 of the 20 with moderate infection. Furthermore, 10 of the 17 healthy pregnant controls had mildly low IgG2, although their diminished levels were nonetheless significantly higher than those of the pregnant women hospitalized for H1N1 infection.

Severe H1N1 infection was also associated with low total IgG, anemia, and hypoalbuminemia, although multivariate analysis revealed that the associations were significant only for low mean IgG2 and hypoalbuminemia.

Follow-up of 15 surviving H1N1-infected, IgG2-deficient patients showed that 11 remained IgG2-deficient at 90 days, well after recovery from their acute disease episode. In contrast, hypoalbuminemia typically resolved within 30 days (Clin. Infect. Dis. 2010;50:672-8).

The investigators argued that long-term follow-up may be warranted in patients sick enough to require hospitalization for H1N1 infection, since the late implications of lingering IgG2 deficiency in this population are unclear. For example, it is not known whether such patients will have a diminished immunologic response to influenza vaccination.

In terms of the potential therapeutic implications of the Australian findings, the investigators noted that administration of convalescent blood products during the 1918 H1N1 flu pandemic resulted in a survival benefit. Inspired by that experience, the Australians have given pooled immunoglobulins to several IgG2-deficient patients with severe H1N1 infection, although they are unclear whether the immunoglobulins had an effect because they weren't given under a study protocol.

Dr. Huitt said the Australian study raises an intriguing hypothesis: “The question is, was this virus selective in choosing those who may be living with a slightly low IgG2, and then overwhelming the immune system's ability to fight the cascade induced by that infection?

“This is something that needs a lot more work,” Dr. Huitt said at the meeting, which was sponsored by the National Jewish Medical and Research Center.

IgG2 subclass deficiency is typically asymptomatic.

Disclosures: The study was funded by the National Health and Medical Research Council of Australia. Dr. Huitt reported having no relevant financial conflicts.

KEYSTONE, COLO. — The explanation for pregnancy as a risk factor for severe pandemic 2009 H1N1 influenza infection may lie in a newly described association between the severity of H1N1 disease and the presence of IgG2 subclass deficiency.

This finding by Australian investigators, if confirmed, may not only shed new light on the pathogenesis of severe H1N1 infection but also prove to have important therapeutic implications, Dr. Gwen Huitt observed at a meeting on allergy and respiratory diseases.

Early in the pandemic, pregnant women were identified as one of the groups at particularly high risk for severe infection requiring ICU admission. Other high-risk groups included children less than 2 years of age, the obese, and individuals with chronic lung, heart, or kidney disease. The mechanisms underlying this increased risk have been unclear, said Dr. Huitt, professor of medicine at the University of Colorado and director of the adult infectious disease care unit at National Jewish Health, both in Denver.

Investigators in Melbourne decided to assess total IgG and IgG subclasses in a consecutive series of patients requiring ICU admission for pandemic flu. The impetus for their study came when they noted IgG2 subclass deficiency in a pregnant woman admitted to the ICU for severe H1N1 disease.

The study population consisted of 39 patients hospitalized for H1N1 infection and 17 healthy pregnant controls. A total of 19 patients had severe infection, meaning they required mechanical ventilation and ICU admission. Twenty others had moderate H1N1 disease, defined by hospitalization without ICU care. A total of 7 of the 19 patients with severe infection were pregnant, as were 2 of 20 with moderate infection.

Fifteen of the 19 patients with severe H1N1 infection had low IgG2, with a mean value of 1.8 g/L, as did 5 of the 20 with moderate infection. Furthermore, 10 of the 17 healthy pregnant controls had mildly low IgG2, although their diminished levels were nonetheless significantly higher than those of the pregnant women hospitalized for H1N1 infection.

Severe H1N1 infection was also associated with low total IgG, anemia, and hypoalbuminemia, although multivariate analysis revealed that the associations were significant only for low mean IgG2 and hypoalbuminemia.

Follow-up of 15 surviving H1N1-infected, IgG2-deficient patients showed that 11 remained IgG2-deficient at 90 days, well after recovery from their acute disease episode. In contrast, hypoalbuminemia typically resolved within 30 days (Clin. Infect. Dis. 2010;50:672-8).

The investigators argued that long-term follow-up may be warranted in patients sick enough to require hospitalization for H1N1 infection, since the late implications of lingering IgG2 deficiency in this population are unclear. For example, it is not known whether such patients will have a diminished immunologic response to influenza vaccination.

In terms of the potential therapeutic implications of the Australian findings, the investigators noted that administration of convalescent blood products during the 1918 H1N1 flu pandemic resulted in a survival benefit. Inspired by that experience, the Australians have given pooled immunoglobulins to several IgG2-deficient patients with severe H1N1 infection, although they are unclear whether the immunoglobulins had an effect because they weren't given under a study protocol.

Dr. Huitt said the Australian study raises an intriguing hypothesis: “The question is, was this virus selective in choosing those who may be living with a slightly low IgG2, and then overwhelming the immune system's ability to fight the cascade induced by that infection?

“This is something that needs a lot more work,” Dr. Huitt said at the meeting, which was sponsored by the National Jewish Medical and Research Center.

IgG2 subclass deficiency is typically asymptomatic.

Disclosures: The study was funded by the National Health and Medical Research Council of Australia. Dr. Huitt reported having no relevant financial conflicts.

The Management of Myelomeningocele Study (MOMS) is a randomized, controlled clinical trial that continues to enroll pregnant women between 19 and 25 weeks' gestation. Funded by the National Institute of Child Health and Human Development, the trial will compare the safety and efficacy of prenatal versus postnatal closure of myelomeningocele. Participating MOMS centers are the Children's Hospital of Philadelphia; Vanderbilt University Medical Center in Nashville, Tenn.; and the University of California at San Francisco.

To refer a patient or for more information, contact study coordinator Jessica Ratay at 866-275-6667 or [email protected]www.spinabifidamoms.com

The Management of Myelomeningocele Study (MOMS) is a randomized, controlled clinical trial that continues to enroll pregnant women between 19 and 25 weeks' gestation. Funded by the National Institute of Child Health and Human Development, the trial will compare the safety and efficacy of prenatal versus postnatal closure of myelomeningocele. Participating MOMS centers are the Children's Hospital of Philadelphia; Vanderbilt University Medical Center in Nashville, Tenn.; and the University of California at San Francisco.

To refer a patient or for more information, contact study coordinator Jessica Ratay at 866-275-6667 or [email protected]www.spinabifidamoms.com

The Management of Myelomeningocele Study (MOMS) is a randomized, controlled clinical trial that continues to enroll pregnant women between 19 and 25 weeks' gestation. Funded by the National Institute of Child Health and Human Development, the trial will compare the safety and efficacy of prenatal versus postnatal closure of myelomeningocele. Participating MOMS centers are the Children's Hospital of Philadelphia; Vanderbilt University Medical Center in Nashville, Tenn.; and the University of California at San Francisco.

To refer a patient or for more information, contact study coordinator Jessica Ratay at 866-275-6667 or [email protected]www.spinabifidamoms.com

Healthy term infants and their mothers should receive individualized care during their hospital stay, but pediatricians, obstetricians, nurses, and other health care providers should work together to determine the optimal time for hospital discharge for each mother-infant dyad, according to a policy statement issued by the American Academy of Pediatrics.

“There have been new studies since [the previous policy statement was published in 2004] to find out if there are better ways to assess the readiness for discharge of a healthy term infant, and these studies have shown that perceptions of readiness or unreadiness at the time of discharge often differ among pediatricians, obstetricians, and mothers,” said lead author and neonatologist Praveen Kumar of Northwestern University, Chicago.

The new statement recommends that “the hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home.”

Dr. Kumar and eight other members of the AAP's Committee on Fetus and Newborn wrote the statement, which recommends following a set of 16 minimum criteria before discharging a term newborn (Pediatrics 2010;125:405-9).

“It is our recommendation that all hospitals should develop guidelines in collaboration with appropriate community agencies and third-party payers, to establish hospital-stay and follow-up programs for healthy term infants that implement these recommendations,” Dr. Kumar said in an interview.

The statement also recommends that physicians use the AAP's Safe and Healthy Beginnings toolkit, which contains a discharge readiness checklist that can aid clinicians with the preparation of a newborn for discharge (http://practice.aap.org/public/Newborn_Discharge_SAMPLE.pdf

In making discharge assessments, the committee advises determining that the clinical course and physical examination of the newborn reveal no abnormalities that require additional hospitalization; vital signs are within normal ranges; and there is a history of successful feedings, urinations, and bowel movements and a lack of significant circumcisional bleeding. Other examinations should assess for the clinical risk of hyperbilirubinemia, and for sepsis based on maternal risk factors and in accord with guidelines for preventing perinatal group B streptococcal disease.

Testing of newborns' blood type as well as their cord blood should be performed as clinically indicated. Hospital protocols and state regulations may call for other metabolic and hearing screenings. The initial hepatitis B vaccine also should be administered to the newborn according to the current immunization schedule.

Mothers should have certain blood tests performed, including screening tests for syphilis and hepatitis B surface antigen and other tests required by state regulations, such as HIV testing. Other assessments need to be made of the mother's knowledge, ability, and confidence to provide adequate care for her infant—including barriers to adequate follow-up care for the newborn—as well as any family, environmental, and social risk factors.

“One of the take-home messages is that the length of stay should accommodate the unique characteristics of each mother-infant dyad, including the health of the mother, the health and stability of the infant, the ability and confidence of the mother to care for her infant, the adequacy of support systems at home, and access to appropriate follow-up care.

To accomplish this, a pediatrician's decision to discharge a newborn should be made jointly with input from the mother, her obstetrician, and other health care providers who are involved in the care of the mother and her infant, such as nursing staff and social workers,” Dr. Kumar said.

“Everything should be considered as a mother-infant dyad rather than independently for the mother and infant. Just looking at the baby and making a decision that the baby can go home” is not adequate, he added.

Once a medical home for the newborn has been identified and a plan for timely communication of pertinent clinical information to the medical home is in place, the committee recommends making a follow-up appointment for the infant within 48 hours of discharge, but no later than 72 hours, if the infant was discharged less than 48 hours after delivery.

“It is very important for all babies to have a medical home, and it should be in place before a baby goes home,” Dr. Kumar said.

Disclosures: None was reported.

The new policy recommends following 16 minimum criteria before discharge.

Source ©Gary Martin/istockphoto.com

Healthy term infants and their mothers should receive individualized care during their hospital stay, but pediatricians, obstetricians, nurses, and other health care providers should work together to determine the optimal time for hospital discharge for each mother-infant dyad, according to a policy statement issued by the American Academy of Pediatrics.

“There have been new studies since [the previous policy statement was published in 2004] to find out if there are better ways to assess the readiness for discharge of a healthy term infant, and these studies have shown that perceptions of readiness or unreadiness at the time of discharge often differ among pediatricians, obstetricians, and mothers,” said lead author and neonatologist Praveen Kumar of Northwestern University, Chicago.

The new statement recommends that “the hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home.”

Dr. Kumar and eight other members of the AAP's Committee on Fetus and Newborn wrote the statement, which recommends following a set of 16 minimum criteria before discharging a term newborn (Pediatrics 2010;125:405-9).

“It is our recommendation that all hospitals should develop guidelines in collaboration with appropriate community agencies and third-party payers, to establish hospital-stay and follow-up programs for healthy term infants that implement these recommendations,” Dr. Kumar said in an interview.

The statement also recommends that physicians use the AAP's Safe and Healthy Beginnings toolkit, which contains a discharge readiness checklist that can aid clinicians with the preparation of a newborn for discharge (http://practice.aap.org/public/Newborn_Discharge_SAMPLE.pdf

In making discharge assessments, the committee advises determining that the clinical course and physical examination of the newborn reveal no abnormalities that require additional hospitalization; vital signs are within normal ranges; and there is a history of successful feedings, urinations, and bowel movements and a lack of significant circumcisional bleeding. Other examinations should assess for the clinical risk of hyperbilirubinemia, and for sepsis based on maternal risk factors and in accord with guidelines for preventing perinatal group B streptococcal disease.

Testing of newborns' blood type as well as their cord blood should be performed as clinically indicated. Hospital protocols and state regulations may call for other metabolic and hearing screenings. The initial hepatitis B vaccine also should be administered to the newborn according to the current immunization schedule.

Mothers should have certain blood tests performed, including screening tests for syphilis and hepatitis B surface antigen and other tests required by state regulations, such as HIV testing. Other assessments need to be made of the mother's knowledge, ability, and confidence to provide adequate care for her infant—including barriers to adequate follow-up care for the newborn—as well as any family, environmental, and social risk factors.

“One of the take-home messages is that the length of stay should accommodate the unique characteristics of each mother-infant dyad, including the health of the mother, the health and stability of the infant, the ability and confidence of the mother to care for her infant, the adequacy of support systems at home, and access to appropriate follow-up care.

To accomplish this, a pediatrician's decision to discharge a newborn should be made jointly with input from the mother, her obstetrician, and other health care providers who are involved in the care of the mother and her infant, such as nursing staff and social workers,” Dr. Kumar said.

“Everything should be considered as a mother-infant dyad rather than independently for the mother and infant. Just looking at the baby and making a decision that the baby can go home” is not adequate, he added.

Once a medical home for the newborn has been identified and a plan for timely communication of pertinent clinical information to the medical home is in place, the committee recommends making a follow-up appointment for the infant within 48 hours of discharge, but no later than 72 hours, if the infant was discharged less than 48 hours after delivery.

“It is very important for all babies to have a medical home, and it should be in place before a baby goes home,” Dr. Kumar said.

Disclosures: None was reported.

The new policy recommends following 16 minimum criteria before discharge.

Source ©Gary Martin/istockphoto.com

Healthy term infants and their mothers should receive individualized care during their hospital stay, but pediatricians, obstetricians, nurses, and other health care providers should work together to determine the optimal time for hospital discharge for each mother-infant dyad, according to a policy statement issued by the American Academy of Pediatrics.

“There have been new studies since [the previous policy statement was published in 2004] to find out if there are better ways to assess the readiness for discharge of a healthy term infant, and these studies have shown that perceptions of readiness or unreadiness at the time of discharge often differ among pediatricians, obstetricians, and mothers,” said lead author and neonatologist Praveen Kumar of Northwestern University, Chicago.

The new statement recommends that “the hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home.”

Dr. Kumar and eight other members of the AAP's Committee on Fetus and Newborn wrote the statement, which recommends following a set of 16 minimum criteria before discharging a term newborn (Pediatrics 2010;125:405-9).

“It is our recommendation that all hospitals should develop guidelines in collaboration with appropriate community agencies and third-party payers, to establish hospital-stay and follow-up programs for healthy term infants that implement these recommendations,” Dr. Kumar said in an interview.

The statement also recommends that physicians use the AAP's Safe and Healthy Beginnings toolkit, which contains a discharge readiness checklist that can aid clinicians with the preparation of a newborn for discharge (http://practice.aap.org/public/Newborn_Discharge_SAMPLE.pdf

In making discharge assessments, the committee advises determining that the clinical course and physical examination of the newborn reveal no abnormalities that require additional hospitalization; vital signs are within normal ranges; and there is a history of successful feedings, urinations, and bowel movements and a lack of significant circumcisional bleeding. Other examinations should assess for the clinical risk of hyperbilirubinemia, and for sepsis based on maternal risk factors and in accord with guidelines for preventing perinatal group B streptococcal disease.

Testing of newborns' blood type as well as their cord blood should be performed as clinically indicated. Hospital protocols and state regulations may call for other metabolic and hearing screenings. The initial hepatitis B vaccine also should be administered to the newborn according to the current immunization schedule.

Mothers should have certain blood tests performed, including screening tests for syphilis and hepatitis B surface antigen and other tests required by state regulations, such as HIV testing. Other assessments need to be made of the mother's knowledge, ability, and confidence to provide adequate care for her infant—including barriers to adequate follow-up care for the newborn—as well as any family, environmental, and social risk factors.

“One of the take-home messages is that the length of stay should accommodate the unique characteristics of each mother-infant dyad, including the health of the mother, the health and stability of the infant, the ability and confidence of the mother to care for her infant, the adequacy of support systems at home, and access to appropriate follow-up care.

To accomplish this, a pediatrician's decision to discharge a newborn should be made jointly with input from the mother, her obstetrician, and other health care providers who are involved in the care of the mother and her infant, such as nursing staff and social workers,” Dr. Kumar said.

“Everything should be considered as a mother-infant dyad rather than independently for the mother and infant. Just looking at the baby and making a decision that the baby can go home” is not adequate, he added.

Once a medical home for the newborn has been identified and a plan for timely communication of pertinent clinical information to the medical home is in place, the committee recommends making a follow-up appointment for the infant within 48 hours of discharge, but no later than 72 hours, if the infant was discharged less than 48 hours after delivery.

“It is very important for all babies to have a medical home, and it should be in place before a baby goes home,” Dr. Kumar said.

Disclosures: None was reported.

The new policy recommends following 16 minimum criteria before discharge.

Source ©Gary Martin/istockphoto.com

CHICAGO — Central arterial compliance is improved following magnesium infusion in women with preeclampsia, according to a prospective, observational study in 70 patients.

“Magnesium may improve perfusion to end organs by decreasing arterial stiffness, suggesting a benefit beyond seizure prophylaxis,” Dr. Dennie Rogers said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a normal pregnancy, arterial compliance increases by 30% in the first trimester and remains elevated until returning to normal levels 6 weeks post partum. Enhanced arterial compliance is part of the normal adaptation to increased intravascular volume during pregnancy. In preeclampsia, this adaptive mechanism is blunted, explained Dr. Rogers, an ob.gyn. at the University of Illinois at Chicago.

The investigators used applanation tonometry to capture radial pulse waveforms at four time points in 70 women with preeclampsia undergoing magnesium therapy for seizure prophylaxis. From these waveforms they derived the aortic waveform and calculated the augmentation pressure (AP) index and augmentation index corrected at 75 beats per minute (Alx@75). The indices are surrogate measures of arterial compliance. The four time points measured were before magnesium administration, 1 hour after a magnesium bolus, 4 hours after maintenance magnesium infusion, and 24 hours after magnesium infusion completion.

The AP and Alx@75 values were significantly lower at all three times points following magnesium administration, compared with pre-magnesium administration, indicating an improvement in radial stiffness, she said. The effect was most pronounced 4 hours after the infusion began, but persisted for 24 hours following magnesium completion. Notably, brachial blood pressures were not clinically or statistically different at any time line, suggesting that arterial compliance cannot be reliably inferred from traditional brachial pressure.

“Our research suggests that central arterial pressure waveforms may better characterize the pulsatile component of the vascular system,” she said. “This may lead to more effective dosing of medications and improved treatment of hypertensive disorders in pregnancy.”

During a discussion of the study, Dr. Rogers noted that use of radial artery pulse waveforms has been validated in nonpregnant populations but not in pregnancy. Session moderator Dr. Norman Gant of the University of Texas at Dallas, said that another team of investigators observed the same findings using magnesium in pregnant women, but these results were not written down.

Disclosures: None was reported.

CHICAGO — Central arterial compliance is improved following magnesium infusion in women with preeclampsia, according to a prospective, observational study in 70 patients.

“Magnesium may improve perfusion to end organs by decreasing arterial stiffness, suggesting a benefit beyond seizure prophylaxis,” Dr. Dennie Rogers said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a normal pregnancy, arterial compliance increases by 30% in the first trimester and remains elevated until returning to normal levels 6 weeks post partum. Enhanced arterial compliance is part of the normal adaptation to increased intravascular volume during pregnancy. In preeclampsia, this adaptive mechanism is blunted, explained Dr. Rogers, an ob.gyn. at the University of Illinois at Chicago.

The investigators used applanation tonometry to capture radial pulse waveforms at four time points in 70 women with preeclampsia undergoing magnesium therapy for seizure prophylaxis. From these waveforms they derived the aortic waveform and calculated the augmentation pressure (AP) index and augmentation index corrected at 75 beats per minute (Alx@75). The indices are surrogate measures of arterial compliance. The four time points measured were before magnesium administration, 1 hour after a magnesium bolus, 4 hours after maintenance magnesium infusion, and 24 hours after magnesium infusion completion.

The AP and Alx@75 values were significantly lower at all three times points following magnesium administration, compared with pre-magnesium administration, indicating an improvement in radial stiffness, she said. The effect was most pronounced 4 hours after the infusion began, but persisted for 24 hours following magnesium completion. Notably, brachial blood pressures were not clinically or statistically different at any time line, suggesting that arterial compliance cannot be reliably inferred from traditional brachial pressure.

“Our research suggests that central arterial pressure waveforms may better characterize the pulsatile component of the vascular system,” she said. “This may lead to more effective dosing of medications and improved treatment of hypertensive disorders in pregnancy.”

During a discussion of the study, Dr. Rogers noted that use of radial artery pulse waveforms has been validated in nonpregnant populations but not in pregnancy. Session moderator Dr. Norman Gant of the University of Texas at Dallas, said that another team of investigators observed the same findings using magnesium in pregnant women, but these results were not written down.

Disclosures: None was reported.

CHICAGO — Central arterial compliance is improved following magnesium infusion in women with preeclampsia, according to a prospective, observational study in 70 patients.

“Magnesium may improve perfusion to end organs by decreasing arterial stiffness, suggesting a benefit beyond seizure prophylaxis,” Dr. Dennie Rogers said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a normal pregnancy, arterial compliance increases by 30% in the first trimester and remains elevated until returning to normal levels 6 weeks post partum. Enhanced arterial compliance is part of the normal adaptation to increased intravascular volume during pregnancy. In preeclampsia, this adaptive mechanism is blunted, explained Dr. Rogers, an ob.gyn. at the University of Illinois at Chicago.

The investigators used applanation tonometry to capture radial pulse waveforms at four time points in 70 women with preeclampsia undergoing magnesium therapy for seizure prophylaxis. From these waveforms they derived the aortic waveform and calculated the augmentation pressure (AP) index and augmentation index corrected at 75 beats per minute (Alx@75). The indices are surrogate measures of arterial compliance. The four time points measured were before magnesium administration, 1 hour after a magnesium bolus, 4 hours after maintenance magnesium infusion, and 24 hours after magnesium infusion completion.

The AP and Alx@75 values were significantly lower at all three times points following magnesium administration, compared with pre-magnesium administration, indicating an improvement in radial stiffness, she said. The effect was most pronounced 4 hours after the infusion began, but persisted for 24 hours following magnesium completion. Notably, brachial blood pressures were not clinically or statistically different at any time line, suggesting that arterial compliance cannot be reliably inferred from traditional brachial pressure.

“Our research suggests that central arterial pressure waveforms may better characterize the pulsatile component of the vascular system,” she said. “This may lead to more effective dosing of medications and improved treatment of hypertensive disorders in pregnancy.”

During a discussion of the study, Dr. Rogers noted that use of radial artery pulse waveforms has been validated in nonpregnant populations but not in pregnancy. Session moderator Dr. Norman Gant of the University of Texas at Dallas, said that another team of investigators observed the same findings using magnesium in pregnant women, but these results were not written down.

Disclosures: None was reported.

Major Finding: About 30 g of dark chocolate per day during pregnancy was associated with systolic and diastolic blood pressure levels that were lower by 8.32 mm Hg and 3.76 mm Hg, respectively, than those of women in a control group.

Data Source: Longitudinal study in 80 women.

Disclosures: None was reported.

CHICAGO — A daily dosage of 30 g of dark chocolate during pregnancy was associated with lower blood pressures and a reduced risk of anemia, Italian researchers reported.

Oral glucose tolerance testing revealed no alterations in the 40 women fed dark chocolate, while gestational diabetes was detected in 2 of the 40 controls, Dr. Gian Carlo Di Renzo, chair of obstetrics and gynecology at the University of Perugia (Italy), and his colleagues reported in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” they wrote.

Women were fed dark chocolate beginning at their first prenatal visit at 9-12 weeks. None of the women given dark chocolate developed anemia in pregnancy, but 65% of controls needed iron supplementation starting at 24 weeks' gestation.

The 30 g of chocolate, 70% cocoa content, contained 10 mg of iron, 6 mcg of folic acid, 0.3 mg of vitamin E, 194 mg of theobromine and 29.4 mg of flavonols.

In a prospective cohort of 2,291 pregnant women, Yale University investigators reported that chocolate consumption was associated with a lower risk of preeclampsia, a pregnancy complication that shares many characteristics of cardiovascular disease including endothelial dysfunction (Epidemiology. 2008;19:459-64).

In the current analysis, blood pressure values were lower at all time points during gestation among women eating chocolate. At the final checkup before they gave birth, controls had systolic and diastolic blood pressure levels that were higher by 8.32 mm Hg and 3.76 mm Hg.

The 160-calorie dose of dark chocolate did not affect weight gain. Cesarean section rates were also equivalent at 32% in both groups.

“Dark chocolate is a well-accepted and valuable supplemental food in pregnancy,” they wrote.

Major Finding: About 30 g of dark chocolate per day during pregnancy was associated with systolic and diastolic blood pressure levels that were lower by 8.32 mm Hg and 3.76 mm Hg, respectively, than those of women in a control group.

Data Source: Longitudinal study in 80 women.

Disclosures: None was reported.

CHICAGO — A daily dosage of 30 g of dark chocolate during pregnancy was associated with lower blood pressures and a reduced risk of anemia, Italian researchers reported.

Oral glucose tolerance testing revealed no alterations in the 40 women fed dark chocolate, while gestational diabetes was detected in 2 of the 40 controls, Dr. Gian Carlo Di Renzo, chair of obstetrics and gynecology at the University of Perugia (Italy), and his colleagues reported in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” they wrote.

Women were fed dark chocolate beginning at their first prenatal visit at 9-12 weeks. None of the women given dark chocolate developed anemia in pregnancy, but 65% of controls needed iron supplementation starting at 24 weeks' gestation.

The 30 g of chocolate, 70% cocoa content, contained 10 mg of iron, 6 mcg of folic acid, 0.3 mg of vitamin E, 194 mg of theobromine and 29.4 mg of flavonols.

In a prospective cohort of 2,291 pregnant women, Yale University investigators reported that chocolate consumption was associated with a lower risk of preeclampsia, a pregnancy complication that shares many characteristics of cardiovascular disease including endothelial dysfunction (Epidemiology. 2008;19:459-64).

In the current analysis, blood pressure values were lower at all time points during gestation among women eating chocolate. At the final checkup before they gave birth, controls had systolic and diastolic blood pressure levels that were higher by 8.32 mm Hg and 3.76 mm Hg.

The 160-calorie dose of dark chocolate did not affect weight gain. Cesarean section rates were also equivalent at 32% in both groups.

“Dark chocolate is a well-accepted and valuable supplemental food in pregnancy,” they wrote.

Major Finding: About 30 g of dark chocolate per day during pregnancy was associated with systolic and diastolic blood pressure levels that were lower by 8.32 mm Hg and 3.76 mm Hg, respectively, than those of women in a control group.

Data Source: Longitudinal study in 80 women.

Disclosures: None was reported.

CHICAGO — A daily dosage of 30 g of dark chocolate during pregnancy was associated with lower blood pressures and a reduced risk of anemia, Italian researchers reported.

Oral glucose tolerance testing revealed no alterations in the 40 women fed dark chocolate, while gestational diabetes was detected in 2 of the 40 controls, Dr. Gian Carlo Di Renzo, chair of obstetrics and gynecology at the University of Perugia (Italy), and his colleagues reported in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” they wrote.

Women were fed dark chocolate beginning at their first prenatal visit at 9-12 weeks. None of the women given dark chocolate developed anemia in pregnancy, but 65% of controls needed iron supplementation starting at 24 weeks' gestation.

The 30 g of chocolate, 70% cocoa content, contained 10 mg of iron, 6 mcg of folic acid, 0.3 mg of vitamin E, 194 mg of theobromine and 29.4 mg of flavonols.

In a prospective cohort of 2,291 pregnant women, Yale University investigators reported that chocolate consumption was associated with a lower risk of preeclampsia, a pregnancy complication that shares many characteristics of cardiovascular disease including endothelial dysfunction (Epidemiology. 2008;19:459-64).

In the current analysis, blood pressure values were lower at all time points during gestation among women eating chocolate. At the final checkup before they gave birth, controls had systolic and diastolic blood pressure levels that were higher by 8.32 mm Hg and 3.76 mm Hg.

The 160-calorie dose of dark chocolate did not affect weight gain. Cesarean section rates were also equivalent at 32% in both groups.

“Dark chocolate is a well-accepted and valuable supplemental food in pregnancy,” they wrote.

Major Finding: At 32-36 weeks' gestation, a 6.7-g increase in fetal birth weight was associated with a 1-mg/dL decrease in HDL cholesterol.

Data Source: A prospective study of 143 women whose cholesterol and triglyceride levels and whose fetuses' birth weights were measured five times during pregnancy.

Disclosures: The study was funded by the Doris Duke Charitable Foundation Clinical Research Fellowship and the National Institutes of Health. The authors disclosed no conflicts of interest.

CHICAGO — Decreased maternal HDL cholesterol during pregnancy is significantly associated with increased fetal birth weight, according to initial data from the ongoing prospective, longitudinal GROW study.

This association was particularly apparent in overweight and obese women, Dr. Uma Perni and Dr. Vinod K. Misra, both of the University of Michigan, Ann Arbor, wrote in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“We believe that having an unhealthy lipid profile may be part of what causes large infants, who then are later at risk for chronic diseases in their lifetime,” Dr. Perni said in an interview.

Prenatal events are thought to establish lifelong physiological patterns that may manifest as diseases in later life. In 1995, the British Medical Journal named this idea the “Barker Hypothesis” based on work by British physician and epidemiologist David Barker who demonstrated that people who had a low birth weight are at greater risk of developing coronary heart disease.

The Gestational Regulators of Weight (GROW) study is the first to document the relationship between variations in birth weight and maternal serum lipids measured at multiple time points during pregnancy, according to the authors.

The researchers measured serum levels of triglycerides, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and total cholesterol in 143 women at five time points during pregnancy: 6-10 weeks' gestation, 10-14 weeks, 16-20 weeks, 22-26 weeks, and 32-36 weeks. Linear regression analyses were conducted, with fetal birth weight adjusted for gestational age determined by a first-trimester dating scan.

In all, 85 women had a low/normal weight (body mass index 18-26 kg/m

A significant inverse relationship was observed between adjusted birth weight and HDL-C at all five time points, reported Dr. Perni, an ob.gyn. at the University of Michigan, and Dr. Misra of the department of pediatrics and communicable diseases at C.S. Mott Children's Hospital, Ann Arbor. For example, at 32-36 weeks' gestation, a 6.7-g increase in birth weight was associated with a 1-mg/dL decrease in HDL-C. The increase in birth weight associated with a 1-mg/dL decrease in HDL-C was 5.7 g at 6-10 weeks' gestation, 5.4 g at 10-14 weeks, 5.0 g at 16-20 weeks, and 6.2 g at 22-26 weeks. Birth weight was also significantly associated with triglycerides at 10-14 weeks' gestation, 22-26 weeks, and 32-36 weeks. No significant association was observed between birth weight and total cholesterol or LDL-C at any time point.

After analyses were stratified by maternal prepregnancy BMI, the association between HDL-C and birth weight was significant for low- and normal-weight women only at 32-36 weeks' gestation. At that time point, a 1-mg/dL decrease in HDL-C was associated with an increased birth weight of 5.4 g. The association, however, remained significant for overweight and obese women at all time points, the authors reported. At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL-C was associated with an increased birth weight of 9.6 g.

“The findings suggest that the metabolic pathways influencing infant health may have very different effects in obese women,” Dr. Misra said in an interview.

Physicians face a clinical dilemma when dealing with hyperlipidemia in pregnant women who are overweight and obese, as statin use is contraindicated in pregnancy.

“One thing that we could look into is preconceptionally optimizing lipid profiles,” Dr. Perni said. “During pregnancy, we need to investigate further the safety of various lipid-lowering medications.”

'Having an unhealthy lipid profile may be part of what causes large infants.'

Source DR. PERNI

Major Finding: At 32-36 weeks' gestation, a 6.7-g increase in fetal birth weight was associated with a 1-mg/dL decrease in HDL cholesterol.

Data Source: A prospective study of 143 women whose cholesterol and triglyceride levels and whose fetuses' birth weights were measured five times during pregnancy.

Disclosures: The study was funded by the Doris Duke Charitable Foundation Clinical Research Fellowship and the National Institutes of Health. The authors disclosed no conflicts of interest.

CHICAGO — Decreased maternal HDL cholesterol during pregnancy is significantly associated with increased fetal birth weight, according to initial data from the ongoing prospective, longitudinal GROW study.

This association was particularly apparent in overweight and obese women, Dr. Uma Perni and Dr. Vinod K. Misra, both of the University of Michigan, Ann Arbor, wrote in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“We believe that having an unhealthy lipid profile may be part of what causes large infants, who then are later at risk for chronic diseases in their lifetime,” Dr. Perni said in an interview.

Prenatal events are thought to establish lifelong physiological patterns that may manifest as diseases in later life. In 1995, the British Medical Journal named this idea the “Barker Hypothesis” based on work by British physician and epidemiologist David Barker who demonstrated that people who had a low birth weight are at greater risk of developing coronary heart disease.

The Gestational Regulators of Weight (GROW) study is the first to document the relationship between variations in birth weight and maternal serum lipids measured at multiple time points during pregnancy, according to the authors.

The researchers measured serum levels of triglycerides, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and total cholesterol in 143 women at five time points during pregnancy: 6-10 weeks' gestation, 10-14 weeks, 16-20 weeks, 22-26 weeks, and 32-36 weeks. Linear regression analyses were conducted, with fetal birth weight adjusted for gestational age determined by a first-trimester dating scan.

In all, 85 women had a low/normal weight (body mass index 18-26 kg/m

A significant inverse relationship was observed between adjusted birth weight and HDL-C at all five time points, reported Dr. Perni, an ob.gyn. at the University of Michigan, and Dr. Misra of the department of pediatrics and communicable diseases at C.S. Mott Children's Hospital, Ann Arbor. For example, at 32-36 weeks' gestation, a 6.7-g increase in birth weight was associated with a 1-mg/dL decrease in HDL-C. The increase in birth weight associated with a 1-mg/dL decrease in HDL-C was 5.7 g at 6-10 weeks' gestation, 5.4 g at 10-14 weeks, 5.0 g at 16-20 weeks, and 6.2 g at 22-26 weeks. Birth weight was also significantly associated with triglycerides at 10-14 weeks' gestation, 22-26 weeks, and 32-36 weeks. No significant association was observed between birth weight and total cholesterol or LDL-C at any time point.

After analyses were stratified by maternal prepregnancy BMI, the association between HDL-C and birth weight was significant for low- and normal-weight women only at 32-36 weeks' gestation. At that time point, a 1-mg/dL decrease in HDL-C was associated with an increased birth weight of 5.4 g. The association, however, remained significant for overweight and obese women at all time points, the authors reported. At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL-C was associated with an increased birth weight of 9.6 g.

“The findings suggest that the metabolic pathways influencing infant health may have very different effects in obese women,” Dr. Misra said in an interview.

Physicians face a clinical dilemma when dealing with hyperlipidemia in pregnant women who are overweight and obese, as statin use is contraindicated in pregnancy.

“One thing that we could look into is preconceptionally optimizing lipid profiles,” Dr. Perni said. “During pregnancy, we need to investigate further the safety of various lipid-lowering medications.”

'Having an unhealthy lipid profile may be part of what causes large infants.'

Source DR. PERNI

Major Finding: At 32-36 weeks' gestation, a 6.7-g increase in fetal birth weight was associated with a 1-mg/dL decrease in HDL cholesterol.

Data Source: A prospective study of 143 women whose cholesterol and triglyceride levels and whose fetuses' birth weights were measured five times during pregnancy.

Disclosures: The study was funded by the Doris Duke Charitable Foundation Clinical Research Fellowship and the National Institutes of Health. The authors disclosed no conflicts of interest.

CHICAGO — Decreased maternal HDL cholesterol during pregnancy is significantly associated with increased fetal birth weight, according to initial data from the ongoing prospective, longitudinal GROW study.

This association was particularly apparent in overweight and obese women, Dr. Uma Perni and Dr. Vinod K. Misra, both of the University of Michigan, Ann Arbor, wrote in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“We believe that having an unhealthy lipid profile may be part of what causes large infants, who then are later at risk for chronic diseases in their lifetime,” Dr. Perni said in an interview.

Prenatal events are thought to establish lifelong physiological patterns that may manifest as diseases in later life. In 1995, the British Medical Journal named this idea the “Barker Hypothesis” based on work by British physician and epidemiologist David Barker who demonstrated that people who had a low birth weight are at greater risk of developing coronary heart disease.

The Gestational Regulators of Weight (GROW) study is the first to document the relationship between variations in birth weight and maternal serum lipids measured at multiple time points during pregnancy, according to the authors.

The researchers measured serum levels of triglycerides, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and total cholesterol in 143 women at five time points during pregnancy: 6-10 weeks' gestation, 10-14 weeks, 16-20 weeks, 22-26 weeks, and 32-36 weeks. Linear regression analyses were conducted, with fetal birth weight adjusted for gestational age determined by a first-trimester dating scan.

In all, 85 women had a low/normal weight (body mass index 18-26 kg/m

A significant inverse relationship was observed between adjusted birth weight and HDL-C at all five time points, reported Dr. Perni, an ob.gyn. at the University of Michigan, and Dr. Misra of the department of pediatrics and communicable diseases at C.S. Mott Children's Hospital, Ann Arbor. For example, at 32-36 weeks' gestation, a 6.7-g increase in birth weight was associated with a 1-mg/dL decrease in HDL-C. The increase in birth weight associated with a 1-mg/dL decrease in HDL-C was 5.7 g at 6-10 weeks' gestation, 5.4 g at 10-14 weeks, 5.0 g at 16-20 weeks, and 6.2 g at 22-26 weeks. Birth weight was also significantly associated with triglycerides at 10-14 weeks' gestation, 22-26 weeks, and 32-36 weeks. No significant association was observed between birth weight and total cholesterol or LDL-C at any time point.

After analyses were stratified by maternal prepregnancy BMI, the association between HDL-C and birth weight was significant for low- and normal-weight women only at 32-36 weeks' gestation. At that time point, a 1-mg/dL decrease in HDL-C was associated with an increased birth weight of 5.4 g. The association, however, remained significant for overweight and obese women at all time points, the authors reported. At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL-C was associated with an increased birth weight of 9.6 g.

“The findings suggest that the metabolic pathways influencing infant health may have very different effects in obese women,” Dr. Misra said in an interview.

Physicians face a clinical dilemma when dealing with hyperlipidemia in pregnant women who are overweight and obese, as statin use is contraindicated in pregnancy.

“One thing that we could look into is preconceptionally optimizing lipid profiles,” Dr. Perni said. “During pregnancy, we need to investigate further the safety of various lipid-lowering medications.”

'Having an unhealthy lipid profile may be part of what causes large infants.'

Source DR. PERNI

Elsevier Global Medical News

Elsevier Global Medical News

Elsevier Global Medical News

Major Finding: The incidence of stillbirth was significantly higher in women with fibroids at 1.6% vs. 0.7% in the no-fibroid group, for an unadjusted relative risk of 2.1.

Data Source: A retrospective cohort study of 64,489 women who underwent routine level II second-trimester ultrasound at a large tertiary care center.

Disclosures: The University of Washington supported the study. Dr. Stout reported no conflicts of interest.

CHICAGO — Women with fibroids have a twofold increased risk of stillbirth, according to a retrospective study of 62,489 pregnancies.

“Although fibroid tumors are typically thought of as benign, they may not in fact be clinically benign,” Dr. Molly Stout said at the annual meeting of the Society for Maternal-Fetal Medicine. “One reasonable approach may be to increase surveillance in the subset of women with fibroids at greatest risk for stillbirth.”

Fibroid tumors are common, occurring in an estimated 1%-20% of reproductive-age women. The incidence in postmortem studies is more than 50%, she noted.

The study population included 72,373 consecutive women with singleton pregnancies who underwent routine level II second-trimester ultrasound between 1990 and 2007 at a large tertiary care center. A total of 8,151 women did not have obstetric follow-up and 1,733 had major fetal anomalies, leaving 62,489 nonanomalous pregnancies available for analysis.

One or more fibroids were present in 2,022, or 3.2%, of the 62,489 pregnancies, reported Dr. Stout of Washington University in St. Louis.

Consistent with prior research, women with fibroids were significantly more likely than those without fibroids to be older (35 years vs. 30 years), to be African American (34.5% vs. 20.3%), to have a higher body mass index (26 kg/m

Stillbirth occurred in 445, or 0.7%, of pregnancies. The incidence of stillbirth was significantly higher in the fibroid group at 1.6% vs. 0.7% in the no-fibroid group (unadjusted relative risk, 2.1), said Dr. Stout of the university's department of obstetrics and gynecology.

The twofold increased risk of stillbirth in the fibroid group persisted in a multivariate analysis, even after covariates of African American race, preexisting diabetes, and chronic hypertension (adjusted odds ratio, 2.1) were controlled for. Age was not significantly associated with stillbirth in the multivariate analysis.

The presence of four or more fibroids (adjusted OR, 2.2) and fibroids 5 cm or more in diameter (adjusted OR, 2.6) were significantly associated with an increased risk of stillbirth. No association was found between stillbirth and location of the fibroid within the uterus or relative to the placenta, Dr. Stout said.

The presence of fetal growth restriction, however, significantly increased the likelihood of stillbirth (RR, 2.6; adjusted OR, 2.5). Among the 7,933 pregnancies with fetal growth restriction, the incidence of stillbirth was 3.9% in women with fibroids vs. 1.5% in those with no fibroids. In pregnancies without fetal growth restriction, the corresponding rates were 0.4% and 0.2%.“Although no known causal pathway can be determined, the increased risk for intrauterine fetal death in the cohort of women with fibroids and a growth-restricted fetus may suggest that the increased risk of fetal demise occurs via a pathway involving growth restriction,” she said.

Another attendee asked whether the investigators observed a pattern as to when the fetal deaths occurred. The incidence of stillbirth occurred relatively equally across gestational ages, with 26.7% occurring at 24-27 weeks' gestation, 16.7% at 28-31 weeks, 24.1% at 32-36 weeks, and 32.5% at 37-42 weeks, Dr. Stout said.

Major Finding: The incidence of stillbirth was significantly higher in women with fibroids at 1.6% vs. 0.7% in the no-fibroid group, for an unadjusted relative risk of 2.1.

Data Source: A retrospective cohort study of 64,489 women who underwent routine level II second-trimester ultrasound at a large tertiary care center.

Disclosures: The University of Washington supported the study. Dr. Stout reported no conflicts of interest.

CHICAGO — Women with fibroids have a twofold increased risk of stillbirth, according to a retrospective study of 62,489 pregnancies.

“Although fibroid tumors are typically thought of as benign, they may not in fact be clinically benign,” Dr. Molly Stout said at the annual meeting of the Society for Maternal-Fetal Medicine. “One reasonable approach may be to increase surveillance in the subset of women with fibroids at greatest risk for stillbirth.”

Fibroid tumors are common, occurring in an estimated 1%-20% of reproductive-age women. The incidence in postmortem studies is more than 50%, she noted.

The study population included 72,373 consecutive women with singleton pregnancies who underwent routine level II second-trimester ultrasound between 1990 and 2007 at a large tertiary care center. A total of 8,151 women did not have obstetric follow-up and 1,733 had major fetal anomalies, leaving 62,489 nonanomalous pregnancies available for analysis.

One or more fibroids were present in 2,022, or 3.2%, of the 62,489 pregnancies, reported Dr. Stout of Washington University in St. Louis.

Consistent with prior research, women with fibroids were significantly more likely than those without fibroids to be older (35 years vs. 30 years), to be African American (34.5% vs. 20.3%), to have a higher body mass index (26 kg/m

Stillbirth occurred in 445, or 0.7%, of pregnancies. The incidence of stillbirth was significantly higher in the fibroid group at 1.6% vs. 0.7% in the no-fibroid group (unadjusted relative risk, 2.1), said Dr. Stout of the university's department of obstetrics and gynecology.

The twofold increased risk of stillbirth in the fibroid group persisted in a multivariate analysis, even after covariates of African American race, preexisting diabetes, and chronic hypertension (adjusted odds ratio, 2.1) were controlled for. Age was not significantly associated with stillbirth in the multivariate analysis.

The presence of four or more fibroids (adjusted OR, 2.2) and fibroids 5 cm or more in diameter (adjusted OR, 2.6) were significantly associated with an increased risk of stillbirth. No association was found between stillbirth and location of the fibroid within the uterus or relative to the placenta, Dr. Stout said.

The presence of fetal growth restriction, however, significantly increased the likelihood of stillbirth (RR, 2.6; adjusted OR, 2.5). Among the 7,933 pregnancies with fetal growth restriction, the incidence of stillbirth was 3.9% in women with fibroids vs. 1.5% in those with no fibroids. In pregnancies without fetal growth restriction, the corresponding rates were 0.4% and 0.2%.“Although no known causal pathway can be determined, the increased risk for intrauterine fetal death in the cohort of women with fibroids and a growth-restricted fetus may suggest that the increased risk of fetal demise occurs via a pathway involving growth restriction,” she said.

Another attendee asked whether the investigators observed a pattern as to when the fetal deaths occurred. The incidence of stillbirth occurred relatively equally across gestational ages, with 26.7% occurring at 24-27 weeks' gestation, 16.7% at 28-31 weeks, 24.1% at 32-36 weeks, and 32.5% at 37-42 weeks, Dr. Stout said.

Major Finding: The incidence of stillbirth was significantly higher in women with fibroids at 1.6% vs. 0.7% in the no-fibroid group, for an unadjusted relative risk of 2.1.

Data Source: A retrospective cohort study of 64,489 women who underwent routine level II second-trimester ultrasound at a large tertiary care center.

Disclosures: The University of Washington supported the study. Dr. Stout reported no conflicts of interest.

CHICAGO — Women with fibroids have a twofold increased risk of stillbirth, according to a retrospective study of 62,489 pregnancies.

“Although fibroid tumors are typically thought of as benign, they may not in fact be clinically benign,” Dr. Molly Stout said at the annual meeting of the Society for Maternal-Fetal Medicine. “One reasonable approach may be to increase surveillance in the subset of women with fibroids at greatest risk for stillbirth.”

Fibroid tumors are common, occurring in an estimated 1%-20% of reproductive-age women. The incidence in postmortem studies is more than 50%, she noted.

The study population included 72,373 consecutive women with singleton pregnancies who underwent routine level II second-trimester ultrasound between 1990 and 2007 at a large tertiary care center. A total of 8,151 women did not have obstetric follow-up and 1,733 had major fetal anomalies, leaving 62,489 nonanomalous pregnancies available for analysis.

One or more fibroids were present in 2,022, or 3.2%, of the 62,489 pregnancies, reported Dr. Stout of Washington University in St. Louis.

Consistent with prior research, women with fibroids were significantly more likely than those without fibroids to be older (35 years vs. 30 years), to be African American (34.5% vs. 20.3%), to have a higher body mass index (26 kg/m

Stillbirth occurred in 445, or 0.7%, of pregnancies. The incidence of stillbirth was significantly higher in the fibroid group at 1.6% vs. 0.7% in the no-fibroid group (unadjusted relative risk, 2.1), said Dr. Stout of the university's department of obstetrics and gynecology.

The twofold increased risk of stillbirth in the fibroid group persisted in a multivariate analysis, even after covariates of African American race, preexisting diabetes, and chronic hypertension (adjusted odds ratio, 2.1) were controlled for. Age was not significantly associated with stillbirth in the multivariate analysis.

The presence of four or more fibroids (adjusted OR, 2.2) and fibroids 5 cm or more in diameter (adjusted OR, 2.6) were significantly associated with an increased risk of stillbirth. No association was found between stillbirth and location of the fibroid within the uterus or relative to the placenta, Dr. Stout said.

The presence of fetal growth restriction, however, significantly increased the likelihood of stillbirth (RR, 2.6; adjusted OR, 2.5). Among the 7,933 pregnancies with fetal growth restriction, the incidence of stillbirth was 3.9% in women with fibroids vs. 1.5% in those with no fibroids. In pregnancies without fetal growth restriction, the corresponding rates were 0.4% and 0.2%.“Although no known causal pathway can be determined, the increased risk for intrauterine fetal death in the cohort of women with fibroids and a growth-restricted fetus may suggest that the increased risk of fetal demise occurs via a pathway involving growth restriction,” she said.

Another attendee asked whether the investigators observed a pattern as to when the fetal deaths occurred. The incidence of stillbirth occurred relatively equally across gestational ages, with 26.7% occurring at 24-27 weeks' gestation, 16.7% at 28-31 weeks, 24.1% at 32-36 weeks, and 32.5% at 37-42 weeks, Dr. Stout said.

Major Finding: For white women, 91% of stillbirths occurred antepartum and only 9% were intrapartum, in contrast to black women, for whom 67% were antepartum and 33% were intrapartum.

Data Source: Population-based, case-control study of 512 stillbirths by the Stillbirth Collaborative Research Network.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Silver disclosed no conflicts of interest.

CHICAGO — Black women are more likely than white women to have stillbirths that are intrapartum and due to obstetric complications and infections, according to an analysis of 512 stillbirths by the Stillbirth Collaborative Research Network.

“The proportion of stillbirths due to various causes differs by race/ethnicity and may contribute to racial disparity in stillbirth,” Dr. Robert M. Silver said at the annual meeting of the Society for Maternal-Fetal Medicine.

Roughly 26,000 stillbirths occur each year in the United States, according to the National Center for Health Statistics (2005 data).

Non-Hispanic blacks have the highest stillbirth rate at 11.1/1,000 live births, compared with the national stillbirth rate of 6.2/1,000 live births in 2005, he noted.

The current analysis was based on all stillbirths and a representative sample of live births occurring from March 2006 to August 2008 in five geographically diverse regions in 59 hospitals.

Of the 958 eligible stillbirths, 512 had complete postmortem examinations. Roughly 36% of women were white; 22.5%, black; 34.5%, Hispanic; and 7%, other.

For white women, 91% of stillbirths occurred antepartum, and only 9% were intrapartum.

This is in contrast to black women, for whom 67% of stillbirths were antepartum and 33% were intrapartum, Dr. Silver reported on behalf of the Stillbirth Collaborative Research Network of the National Institute of Child Health and Human Development.

The investigators were able to identify a probable cause of death in 61% of stillbirths and a possible or probable cause in 81%. Forty percent of cases had more than one possible or probable cause.

The most common cause of stillbirth, occurring in 35% of cases, was placental abnormality due most often to thrombosis, infarction, or placental insufficiency.

Another 29% of cases were associated with an obstetric complication. Of these, half or 15% of the entire cohort were due to a sequence involving cervical insufficiency, preterm labor, and chorioamnionitis, said Dr. Silver, chief of maternal-fetal medicine at the University of Utah in Salt Lake City.

Other stillbirth causes included fetal abnormalities (15%), infection (13%), maternal medical conditions (10.5%), cord abnormalities (10%), and hypertension (9%).

Infection and obstetric complications were more common in intrapartum cases, while placental insufficiency was more frequent in antepartum stillbirth, he said.

Infection occurred in 10% of antepartum vs. 25% of intrapartum stillbirths; obstetric complications, in 15% of antepartum and 100% of intrapartum stillbirths; and placental causes in 39% vs. 19.5%.

Overall, more than one-third of women had stillbirths between 20 and 24 weeks' gestation.

Of note, 78% of intrapartum stillbirths occurred at weeks 20-24, almost exclusively in cases where there was no obstetric intervention for fetal indications due to a previable or periviable gestation.

“Future research should focus on placental and obstetric causes of [stillbirth] and racial disparity in stillbirth,” said Dr. Silver, who described the analysis as the “first scratch of a very large data set.”

Major Finding: For white women, 91% of stillbirths occurred antepartum and only 9% were intrapartum, in contrast to black women, for whom 67% were antepartum and 33% were intrapartum.

Data Source: Population-based, case-control study of 512 stillbirths by the Stillbirth Collaborative Research Network.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Silver disclosed no conflicts of interest.

CHICAGO — Black women are more likely than white women to have stillbirths that are intrapartum and due to obstetric complications and infections, according to an analysis of 512 stillbirths by the Stillbirth Collaborative Research Network.

“The proportion of stillbirths due to various causes differs by race/ethnicity and may contribute to racial disparity in stillbirth,” Dr. Robert M. Silver said at the annual meeting of the Society for Maternal-Fetal Medicine.

Roughly 26,000 stillbirths occur each year in the United States, according to the National Center for Health Statistics (2005 data).

Non-Hispanic blacks have the highest stillbirth rate at 11.1/1,000 live births, compared with the national stillbirth rate of 6.2/1,000 live births in 2005, he noted.

The current analysis was based on all stillbirths and a representative sample of live births occurring from March 2006 to August 2008 in five geographically diverse regions in 59 hospitals.

Of the 958 eligible stillbirths, 512 had complete postmortem examinations. Roughly 36% of women were white; 22.5%, black; 34.5%, Hispanic; and 7%, other.

For white women, 91% of stillbirths occurred antepartum, and only 9% were intrapartum.

This is in contrast to black women, for whom 67% of stillbirths were antepartum and 33% were intrapartum, Dr. Silver reported on behalf of the Stillbirth Collaborative Research Network of the National Institute of Child Health and Human Development.

The investigators were able to identify a probable cause of death in 61% of stillbirths and a possible or probable cause in 81%. Forty percent of cases had more than one possible or probable cause.

The most common cause of stillbirth, occurring in 35% of cases, was placental abnormality due most often to thrombosis, infarction, or placental insufficiency.

Another 29% of cases were associated with an obstetric complication. Of these, half or 15% of the entire cohort were due to a sequence involving cervical insufficiency, preterm labor, and chorioamnionitis, said Dr. Silver, chief of maternal-fetal medicine at the University of Utah in Salt Lake City.

Other stillbirth causes included fetal abnormalities (15%), infection (13%), maternal medical conditions (10.5%), cord abnormalities (10%), and hypertension (9%).

Infection and obstetric complications were more common in intrapartum cases, while placental insufficiency was more frequent in antepartum stillbirth, he said.

Infection occurred in 10% of antepartum vs. 25% of intrapartum stillbirths; obstetric complications, in 15% of antepartum and 100% of intrapartum stillbirths; and placental causes in 39% vs. 19.5%.

Overall, more than one-third of women had stillbirths between 20 and 24 weeks' gestation.

Of note, 78% of intrapartum stillbirths occurred at weeks 20-24, almost exclusively in cases where there was no obstetric intervention for fetal indications due to a previable or periviable gestation.

“Future research should focus on placental and obstetric causes of [stillbirth] and racial disparity in stillbirth,” said Dr. Silver, who described the analysis as the “first scratch of a very large data set.”

Major Finding: For white women, 91% of stillbirths occurred antepartum and only 9% were intrapartum, in contrast to black women, for whom 67% were antepartum and 33% were intrapartum.

Data Source: Population-based, case-control study of 512 stillbirths by the Stillbirth Collaborative Research Network.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Silver disclosed no conflicts of interest.

CHICAGO — Black women are more likely than white women to have stillbirths that are intrapartum and due to obstetric complications and infections, according to an analysis of 512 stillbirths by the Stillbirth Collaborative Research Network.

“The proportion of stillbirths due to various causes differs by race/ethnicity and may contribute to racial disparity in stillbirth,” Dr. Robert M. Silver said at the annual meeting of the Society for Maternal-Fetal Medicine.

Roughly 26,000 stillbirths occur each year in the United States, according to the National Center for Health Statistics (2005 data).

Non-Hispanic blacks have the highest stillbirth rate at 11.1/1,000 live births, compared with the national stillbirth rate of 6.2/1,000 live births in 2005, he noted.

The current analysis was based on all stillbirths and a representative sample of live births occurring from March 2006 to August 2008 in five geographically diverse regions in 59 hospitals.

Of the 958 eligible stillbirths, 512 had complete postmortem examinations. Roughly 36% of women were white; 22.5%, black; 34.5%, Hispanic; and 7%, other.

For white women, 91% of stillbirths occurred antepartum, and only 9% were intrapartum.

This is in contrast to black women, for whom 67% of stillbirths were antepartum and 33% were intrapartum, Dr. Silver reported on behalf of the Stillbirth Collaborative Research Network of the National Institute of Child Health and Human Development.

The investigators were able to identify a probable cause of death in 61% of stillbirths and a possible or probable cause in 81%. Forty percent of cases had more than one possible or probable cause.

The most common cause of stillbirth, occurring in 35% of cases, was placental abnormality due most often to thrombosis, infarction, or placental insufficiency.

Another 29% of cases were associated with an obstetric complication. Of these, half or 15% of the entire cohort were due to a sequence involving cervical insufficiency, preterm labor, and chorioamnionitis, said Dr. Silver, chief of maternal-fetal medicine at the University of Utah in Salt Lake City.

Other stillbirth causes included fetal abnormalities (15%), infection (13%), maternal medical conditions (10.5%), cord abnormalities (10%), and hypertension (9%).

Infection and obstetric complications were more common in intrapartum cases, while placental insufficiency was more frequent in antepartum stillbirth, he said.

Infection occurred in 10% of antepartum vs. 25% of intrapartum stillbirths; obstetric complications, in 15% of antepartum and 100% of intrapartum stillbirths; and placental causes in 39% vs. 19.5%.

Overall, more than one-third of women had stillbirths between 20 and 24 weeks' gestation.

Of note, 78% of intrapartum stillbirths occurred at weeks 20-24, almost exclusively in cases where there was no obstetric intervention for fetal indications due to a previable or periviable gestation.

“Future research should focus on placental and obstetric causes of [stillbirth] and racial disparity in stillbirth,” said Dr. Silver, who described the analysis as the “first scratch of a very large data set.”