541: Women with prior preterm birth and infant death are at risk for short interpregnancy intervals
1
CONCLUSIONS: A short interpregnancy interval is an independent risk factor for all infant mortality, demonstrating that risks of short IPIs persist beyond the perinatal and neonatal periods. Counseling about these 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 associated with short interpregnancy interval modified by maternal characteristics? Allison Bryant 1 , Erin Madden 2 1 Massachusetts General Hospital, Boston, MA, 2 NCIRE, San Francisco, CA OBJECTIVE: It is known that short interpregnancy intervals (IPIs) are associated with infant mortality. We sought to explore whether ma- ternal characteristics modify the risk. STUDY DESIGN: We used data from vital statistics records for all births in California between 1999-2004, linked with hospital discharge data. For women with a first birth in 1999-2000 and a second birth by the end of 2004, multivariable modeling was used to determine the asso- ciation between short IPIs and infant death. Interaction terms be- tween short IPI and maternal race/ethnicity, prior preterm birth, prior fetal death and prior infant death were created and tested for statistically meaningful effect modification (p0.10). RESULTS: 191,081 women met entry criteria. After adjustment for ma- ternal sociodemographic and clinical variables, there was a significant interaction (p 0.04) between the effect of prior preterm birth and IPI 6m on subsequent pregnancy outcome. Women with an IPI 6m and a previous preterm birth had an AOR of a second birth 28 weeks of 2.4 [1.6, 3.5], greater than among women with an IPI 6m but without a prior preterm birth (AOR 1.4 [1.0, 1.9]). The risk of infant death after the second pregnancy was 0.4%. After adjustment, an IPI 6m was significantly associated with the risk of infant death. This association persisted even after adjustment for prematurity in the second pregnancy. There was also an interaction (p 0.09) between the effects of a short IPI and prior preterm birth: the AOR for infant death 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 and no prior preterm birth. There were no other significant interactions. CONCLUSIONS: A short IPI is an independent risk factor for infant mor- tality, even after adjustment for gestational age in the subsequent birth. Women with a history of preterm birth are at additional in- creased risk of infant death when the interpregnancy interval is short. Particular care should be taken to counsel women with poor obstet- rical histories when it comes to birth spacing. 541 Women with prior preterm birth and infant death are at risk for short interpregnancy intervals Allison Bryant 1 , Erin Madden 2 1 Massachusetts General Hospital, Boston, MA, 2 NCIRE, San Francisco, CA OBJECTIVE: We have previously shown that women with a preterm birth in their first pregnancy, particularly a birth 28 weeks gestation, are at increased risk of having another pregnancy within 6 months of the first delivery. We sought to explore possible explanations and modifiers of this risk. STUDY DESIGN: Data from vital statistics records for all births in Cali- fornia between 1999 and 2004 were linked with hospital discharge data. For women with a first birth in 1999-2000, multivariable mod- eling was used to determine risk factors for short birth-to-conception intervals, with an emphasis on the explanatory role of neonatal and postneonatal death. RESULTS: Of 367,710 women with first births in CA in 1999-2000, 0.9% had an interpregnancy interval (IPI) 3 months, 3.3% 6 months and 10.8% 12 months. In multivariable analyses adjusted for maternal demographic, social and clinical factors, women with preterm deliveries in the first pregnancy were more likely to have short IPIs (e.g. AOR for IPI 6 months 1.72 (95% CI [1.39, 2.1]) for women with first birth 28 weeks). This risk was completely atten- uated when neonatal and postneonatal infant mortality were ac- counted for in the model (AOR for IPI 6 months 5.3 [4.4, 6.5] and 2.9 [2.1, 4.0] for infant death 30d and 31-365d, respectively). Fetal death in the first pregnancy was also highly predictive (AOR 6.7 [5.3, 8.6]) of very short IPI. CONCLUSIONS: Women with preterm birth are at higher risk of inade- quate interpregnancy intervals; this risk appears explained by the oc- currence of an infant death. Women with fetal death or preterm births and subsequent infant death may be understandably eager to conceive again soon, but are also at high risk for recurrent adverse outcomes, especially in the setting of short interpregnancy intervals, perhaps due to biological mediators. Such women should be well counseled about these risks, and advised to wait at least 6-12 months prior to attempt- ing a next pregnancy. AOR IPI < 6m Unadjusted for infant death Adjusted for infant 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 promotes postpartum weight loss Amanda Yeaton-Massey 1 , Geri Ottaviano 1 , Christina A. Penfield 1 , Stephanie J. Handler 1 , Jesus M. Granados 1 , Aaron B. Caughey 2 1 University of California, San Francisco, San Francisco, CA, 2 Oregon Health & Science University, Portland, OR OBJECTIVE: To determine whether there is a relationship between postpartum weight loss and exclusive breastfeeding. STUDY DESIGN: This was a cross-sectional self-administered survey of women at least six months postpartum who received prenatal care and delivered at a single institution. Information on method and duration of feeding were obtained in addition to maternal weight at three and six months. Student’s t-test was used to compare rates of weight loss. RESULTS: Women who exclusively breastfed for any amount of time lost more weight at three and six months than their counterparts who fed by breast and bottle or bottle alone (Table). The median duration of breastfeeding was 8 months. Women who breastfed exclusively for at least 8 months had mean weight loss of 30.3lbs versus 26.3lbs for women who fed with breast and bottle (p0.015). CONCLUSIONS: Exclusive breastfeeding is associated with a statistically significant increase in postpartum weight loss. This effect is more www.AJOG.org Epidemiology, Global Maternal-Fetal Public Health, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics Poster Session IV Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology S217
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Transcript of 541: Women with prior preterm birth and infant death are at risk for short interpregnancy intervals
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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 sSupplem
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 moreent to JANUARY 2011 American Journal of Obstetrics & Gynecology S217
