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Poster Session IV www.AJOG.orgFriday, February 11, 2011 • 3:30 pm – 5:30 pm • Grand Ballroom, Hilton San Francisco

EPIDEMIOLOGY, GLOBAL MATERNAL-FETAL PUBLIC HEALTH, INFECTIOUSDISEASE, INTRAPARTUM FETAL ASSESSMENT, OPERATIVE OBSTETRICS

Abstracts 537 – 686

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537 Maternal BMI, glucose tolerance,nd adverse pregnancy outcomes

Alison Stuebe1

1For the Eunice Kennedy Shriver National Institute ofhild Health and Human Development Maternal-etal Medicine Units Network, Bethesda, MD

OBJECTIVE: To measure the independent effects of BMI and glucoseolerance on pregnancy outcome among women with mild gestationallucose intolerance.

STUDY DESIGN: We used logistic regression to model the associationsetween pregravid BMI, 3-hour OGTT results (fasting �95mg/dl,-h, 2-h, and 3-h), and pregnancy outcomes among women enrolledn a multicenter study of treatment of mild GDM and its associatedbservational cohort. We included in our analysis women with a 50-ram screen between 135 and 199 mg/dL who either did not meetriteria for GDM or met criteria for GDM but were randomized to noreatment. All models were adjusted for parity, maternal age and race/thnicity.

RESULTS: Among 1198 women eligible for analysis, both maternalMI and glucose at hour 3 of the OGTT were directly associated withestational hypertension/preeclampsia (OR per 5 BMI unit increase:.29, 95%CI 1.10-1.51; OR per 10 mg/dL 3h glucose increase: 1.09,5%CI 1.01-1.17). Increasing maternal BMI was also positively asso-iated with LGA birth weight (BWT: OR per 5 BMI unit increase 1.21,5%CI 1.03-1.41) and negatively associated with SGA BWT (OR per 5MI unit increase .77, 95%CI .61-.97). Neither BMI nor OGTT valuesere associated with preeclampsia. We did not find a statistically sig-ificant association between maternal BMI, fasting OGTT and theomposite outcome (perinatal mortality, hypoglycemia, hyperbiliru-inemia, neonatal hyperinsulinemia, or birth trauma).

CONCLUSIONS: In a population of untreated women with mild gesta-ional glucose intolerance, BMI is more strongly associated with LGA,GA and gestational hypertension/preeclampsia than parameters ofhe 3-hour OGTT.

Table: Association between pregravid BMI (OR per 5 unit increase, 95% CI), OGTTparameters (OR per 10mg/dL increase, 95% CI), and pregnancy outcomes

Pregravid BMI Fasting OGTT 1-hour OGTT 2-hour OGTT 3-hour OGTT

Mean (SD) 26.6 (5.6) 85 (6) 167 (30) 144 (30) 117 (28)..........................................................................................................................................................................................gHTN/preeclampsia 1.29 (1.10-1.51) 1.04 (.74-1.45) 1.06 (.97-1.15) 1.01 (.92-1.11) 1.09 (1.01-1.17)..........................................................................................................................................................................................LGA 1.21 (1.03-1.41) 1.21 (.88-1.67) 1.01 (.93-1.10) 1.09 (1.00-1.19) 1.00 (.93-1.07)..........................................................................................................................................................................................SGA .77 (.61-.97) .85 (.58-1.24) .97 (.89-1.07) .99 (.89-1.10) .98 (.90-1.07)..........................................................................................................................................................................................Preeclampsia 1.13 (.89-1.43) 1.03 (.63-1.67) 1.04 (.91-1.18) 1.04 (.91-1.19) 1.02 (.91-1.13)..........................................................................................................................................................................................Composite outcome 1.11 (.99-1.25) 1.20 (.97-1.50) 1.03 (.97-1.09) 1.01 (.96-1.08) 1.02 (.97-1.07)..........................................................................................................................................................................................

Bold indicates p �0.05.

538 Is there a threshold OGTT value forredicting adverse neonatal outcome?

Alison Stuebe1

1For the Eunice Kennedy Shriver National Institutef Child Health and Human Development Maternal-etal Medicine Units Network, Bethesda, MD

OBJECTIVE: To determine whether there is an OGTT threshold abovehich glucose intolerance predicts adverse newborn outcomes.

STUDY DESIGN: Among women enrolled in a multicenter study oftreatment of mild GDM and its associated observational cohort, we

used the generalized additive models to explore non-linear associa- t

S216 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

tions between each of the 3-hour OGTT values (fasting, 1-h, 2-h, and3-h) and the study’s composite outcome (perinatal mortality, hypo-glycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/orbirth trauma). Generalized additive models used non-parametric re-gression to identify non-linear associations among predictors andoutcomes. We further modeled the association between OGTT andcomposite outcome using all four OGTT values in a single model. Tobe eligible for inclusion in the study, participants were required tohave a 50g glucose loading test value between 135 and 199 mg/dL anda fasting OGTT value �95 mg/dL. We included in our analysis womenwho either did not meet criteria for GDM or met criteria for mildGDM but were randomized to no treatment.RESULTS: Among 1303 eligible women, each timed OGTT value wasinearly associated with increased odds of the composite outcomeTable). When all four OGTT values were included in a single model,nly fasting OGTT was linearly associated with the composite out-ome (OR per 10 mg/dL increase 1.33, 95% CI 1.09-1.63). We foundo evidence of departure from linearity for any of the OGTT values,ither in single-value models or the model incorporating all four val-es (all Analysis of Deviance Chi-Square p values � 0.4).

CONCLUSIONS: In a population of untreated women with mild gesta-ional glucose intolerance and fasting OGTT � 95 mg/dL, fastingGTT values were directly associated with risk of the composite out-

ome. We found no evidence of threshold OGTT values above whichhere is a non-linear increase in neonatal complications.

Table: Increasing glucose intolerance and composite neonatal outcome (OR per 10 mg/dL)

Fasting OGTT 1h OGTT 2h OGTT 3h OGTT

Mean (SD), mg/dL 85 (6) 167 (30) 144 (30) 117 (28)..........................................................................................................................................................................................Single OGTT value 1.33 (1.09-1.63) 1.07 (1.03-1.11) 1.06 (1.02-1.10) 1.05 (1.01-1.09)..........................................................................................................................................................................................Mutually adjustedfor all 4 OGTTvalues

1.23 (1.00-1.52) 1.04 (.99-1.10) 1.02 (.96-1.08) 1.02 (.98-1.07)

..........................................................................................................................................................................................

539 Short interpregnancy intervals are a risk factoror postneonatal infant mortality: risks are notonfined to the perinatal and neonatal periods

Allison Bryant1, Erin Madden2

1Massachusetts General Hospital, Boston, MA, 2NCIRE, San Francisco, CAOBJECTIVE: It is known that short birth-to-conception intervals aressociated with an increased risk of adverse pregnancy outcomes andf infant death in the first 30 days of life. We sought to determinehether this risk of mortality extends to infant mortality beyond theeonatal period.

STUDY DESIGN: We used data from vital statistics (birth, infant andfetal death) records for all births in California between 1999 and 2004,linked with hospital discharge data. For women with a first birth in1999-2000 and a second birth by the end of 2004, multivariable mod-eling was used to determine the association between short interpreg-nancy intervals (IPIs) and postneonatal death.RESULTS: Of infants born to 191,081 women meeting study criteria,

80 (0.36%) died in the first year of life: 420 (0.22%) died during therst 30 days of life and 260 (0.14%) died between 31 and 365 days of

ife. Significant sociodemographic and clinical risk factors for post-eonatal infant death are presented in the Table. An IPI of �6m was

ndependently and strongly associated with the risk of all infant mor-

ality, including the risk of postneonatal mortality.

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www.AJOG.org Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics Poster Session IV

CONCLUSIONS: A short interpregnancy interval is an independent riskactor for all infant mortality, demonstrating that risks of short IPIsersist beyond the perinatal and neonatal periods. Counseling abouthese adverse risks should be a routine part of all obstetrical care.

Adjusted odds of infant death at 31-365 days among second births

Predictor AOR [95% CI]

Maternal age �40y 4.1 [1.3, 13.3]..........................................................................................................................................................................................

Black race 2.1 [1.3, 3.2]..........................................................................................................................................................................................

East Asian ethnicity 2.2 [1.2, 4.2]..........................................................................................................................................................................................

College graduate (vs. HS) 0.5 [0.3, 0.8]..........................................................................................................................................................................................

Public insurance 1.4 [1.0, 1.9]..........................................................................................................................................................................................

Foreign born 0.7 [0.5, 0.9]..........................................................................................................................................................................................

Inadequate prenatal care 1.4 [1.0, 1.9]..........................................................................................................................................................................................

First infant � 2500g 1.7 [1.1, 2.7]..........................................................................................................................................................................................

Multiple gestation 2.4 [1.1, 5.0]..........................................................................................................................................................................................

Interpregnancy interval � 6m 1.9 [1.3, 2.7]..........................................................................................................................................................................................

540 Is the risk of infant death associatedith short interpregnancy interval modifiedy maternal characteristics?

Allison Bryant1, Erin Madden2

1Massachusetts General Hospital, Boston, MA, 2NCIRE, San Francisco, CAOBJECTIVE: It is known that short interpregnancy intervals (IPIs) aressociated with infant mortality. We sought to explore whether ma-ernal characteristics modify the risk.

STUDY DESIGN: We used data from vital statistics records for all birthsn California between 1999-2004, linked with hospital discharge data.or women with a first birth in 1999-2000 and a second birth by thend of 2004, multivariable modeling was used to determine the asso-iation between short IPIs and infant death. Interaction terms be-ween short IPI and maternal race/ethnicity, prior preterm birth,rior fetal death and prior infant death were created and tested fortatistically meaningful effect modification (p�0.10).

RESULTS: 191,081 women met entry criteria. After adjustment for ma-ernal sociodemographic and clinical variables, there was a significantnteraction (p � 0.04) between the effect of prior preterm birth andPI �6m on subsequent pregnancy outcome. Women with an IPI

6m and a previous preterm birth had an AOR of a second birth �28eeks of 2.4 [1.6, 3.5], greater than among women with an IPI �6mut without a prior preterm birth (AOR 1.4 [1.0, 1.9]). The risk of

nfant death after the second pregnancy was 0.4%. After adjustment,n IPI �6m was significantly associated with the risk of infant death.

This association persisted even after adjustment for prematurity in thesecond pregnancy. There was also an interaction (p � 0.09) betweenthe effects of a short IPI and prior preterm birth: the AOR for infantdeath for women with an IPI � 6m and a prior preterm birth was 2.3[1.4, 3.7], while it was 1.4 [1.1, 1.9] for women with an IPI �6m andno prior preterm birth. There were no other significant interactions.CONCLUSIONS: A short IPI is an independent risk factor for infant mor-ality, even after adjustment for gestational age in the subsequentirth. Women with a history of preterm birth are at additional in-reased risk of infant death when the interpregnancy interval is short.articular care should be taken to counsel women with poor obstet-ical histories when it comes to birth spacing.

541 Women with prior preterm birth and infant deathre at risk for short interpregnancy intervals

Allison Bryant1, Erin Madden2

1Massachusetts General Hospital, Boston, MA, 2NCIRE, San Francisco, CAOBJECTIVE: We have previously shown that women with a preterm

irth in their first pregnancy, particularly a birth � 28 weeks gestation,

re at increased risk of having another pregnancy within 6 months of s

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the first delivery. We sought to explore possible explanations andmodifiers of this risk.STUDY DESIGN: Data from vital statistics records for all births in Cali-fornia between 1999 and 2004 were linked with hospital dischargedata. For women with a first birth in 1999-2000, multivariable mod-eling was used to determine risk factors for short birth-to-conceptionintervals, with an emphasis on the explanatory role of neonatal andpostneonatal death.RESULTS: Of 367,710 women with first births in CA in 1999-2000,

.9% had an interpregnancy interval (IPI) � 3 months, 3.3% � 6onths and 10.8% � 12 months. In multivariable analyses adjusted

or maternal demographic, social and clinical factors, women withreterm deliveries in the first pregnancy were more likely to have shortPIs (e.g. AOR for IPI � 6 months 1.72 (95% CI [1.39, 2.1]) foromen with first birth � 28 weeks). This risk was completely atten-ated when neonatal and postneonatal infant mortality were ac-ounted for in the model (AOR for IPI � 6 months 5.3 [4.4, 6.5] and.9 [2.1, 4.0] for infant death � 30d and 31-365d, respectively). Fetaleath in the first pregnancy was also highly predictive (AOR 6.7 [5.3,.6]) of very short IPI.

CONCLUSIONS: Women with preterm birth are at higher risk of inade-uate interpregnancy intervals; this risk appears explained by the oc-urrence of an infant death. Women with fetal death or preterm birthsnd subsequent infant death may be understandably eager to conceivegain soon, but are also at high risk for recurrent adverse outcomes,specially in the setting of short interpregnancy intervals, perhaps dueo biological mediators. Such women should be well counseled abouthese risks, and advised to wait at least 6-12 months prior to attempt-ng a next pregnancy.

AOR IPI < 6mUnadjusted forinfant death

Adjusted forinfant death

GA at first birth:..........................................................................................................................................................................................

� 37w 1.0 1.0..........................................................................................................................................................................................

32-36w 1.1 [1.0, 1.2] 1.1 [1.0, 1.1]..........................................................................................................................................................................................

28-31w 1.2 [1.0, 1.5] 1,1 [0.9, 1.4]..........................................................................................................................................................................................

�28w 1.7 [1.4, 2.1] 1.2 [0.9, 1.4]..........................................................................................................................................................................................

Fetal death 5.8 [4.5, 7.4] 6.7 [5.3, 8.6]..........................................................................................................................................................................................

Infant death � 30d -- 5.4 [4.4, 6.5]..........................................................................................................................................................................................

Infant death 31-365d -- 2.9 [2.1, 4.0]..........................................................................................................................................................................................

542 Exclusive breastfeeding promotesostpartum weight loss

Amanda Yeaton-Massey1, Geri Ottaviano1, Christina A. Penfield1,tephanie J. Handler1, Jesus M. Granados1, Aaron B. Caughey2

1University of California, San Francisco, San Francisco, CA,2Oregon Health & Science University, Portland, OROBJECTIVE: To determine whether there is a relationship between

ostpartum weight loss and exclusive breastfeeding.STUDY DESIGN: This was a cross-sectional self-administered survey of

omen at least six months postpartum who received prenatal care andelivered at a single institution. Information on method and durationf feeding were obtained in addition to maternal weight at three andix months. Student’s t-test was used to compare rates of weight loss.

RESULTS: Women who exclusively breastfed for any amount of timeost more weight at three and six months than their counterparts whoed by breast and bottle or bottle alone (Table). The median durationf breastfeeding was 8 months. Women who breastfed exclusively fort least 8 months had mean weight loss of 30.3lbs versus 26.3lbs foromen who fed with breast and bottle (p�0.015).

CONCLUSIONS: Exclusive breastfeeding is associated with a statistically

ignificant increase in postpartum weight loss. This effect is more

ent to JANUARY 2011 American Journal of Obstetrics & Gynecology S217