Impact of the Medicaid Family Planning Waiver on Black-White disparities in pregnancy outcomes...
1
349 SERUM PROTEOMIC SCREENING USING SELDI-TOF TO DETECT BIOMARKERS FOR PRETERM LABOR JAY BOLNICK 1 , CHARLOTTE MOBARAK 2 , VIRGINIA SEVERNS 3 , MARIA VELAZQUEZ 1 , CHEN MENG 4 , KIMBERLY LESLIE 1 , 1 University of New Mexico, Obstetrics and Gynecology, Albuquerque, New Mexico, 2 University of New Mexico, Basic Med Sciences, Albuquerque, New Mexico, 3 University of New Mexico, Albuquerque, New Mexico, 4 University of New Mexico, Psychology, Albuquerque, New Mexico OBJECTIVE: To derive an initial proteomic serum screening test to discrim- inate patients with preterm labor from controls which will form the basis for future large-scale validation studies. STUDY DESIGN: To derive an initial algorithm that is sensitive and specific for preterm labor, 28 women between 24 and 34 gestational weeks were recruited to donate serum samples. Fourteen women were in preterm labor with progressive cervical dilatation and effacement and with painful regular uterine contractions. Fourteen gestational-age matched controls delivered at R37 weeks. Serum samples were collected and immediately frozen at ÿ80 degrees C. Samples then underwent fractionization according to pH (range from 9 to 1 pH units) to allow more sensitivity to identify proteins of low abundance. Samples were then subjected to surface enhanced laser desorption and ionization - time of flight (SELDI-TOF) analysis using the IMAC30 (copper metal affinity) Ciphergen ProteinChip Array. Spectra were acquired and analyzed using Ciphergen ProteinChip and Biomarker Patterns software and proprietary programs maintained at our institution. RESULTS: There were statistically significant changes in multiple peptide peaks across fractions in samples from patients with preterm labor compared to controls. Between six and 10 peaks were used to derive predictive algorithms with sensitivities ranging from 72-98% and specificities ranging from 73-86% for each fraction. The best peaks from multiple fractions will now be combined to produce the most predictive algorithm for validation. CONCLUSION: It is possible to derive specific and sensitive algorithms correlating with distinct proteomic profiles in patients with preterm labor compared to controls. These initial investigations will form the basis of larger studies for the refinement of predictive peaks and validation. Current studies are also ongoing to determine the identity of the discriminating proteins. 350 IMPACT OF THE MEDICAID FAMILY PLANNING WAIVER ON BLACK-WHITE DISPARITIES IN PREGNANCY OUTCOMES AMONGST TEENS IN THE STATE OF FLORIDA ALLISON BRYANT 1 , MAGDA PECK 2 , JENNIFER SKALA 2 , PAUL WISE 3 , 1 Brigham and Women’s Hospital, Division of Maternal Fetal Medicine, Boston, Massachusetts, 2 CityMatch at the University of Nebraska, Omaha, Nebraska, 3 Brigham and Women’s Hospital, Divison of Social Medicine and Health Inequalities, Boston, Massachusetts OBJECTIVE: Eighteen states, including Florida, have implemented Medicaid FPWs, providing family planning (FP) and primary care services to women who would otherwise lose Medicaid coverage. Such programs have been evaluated for budget-neutrality and effects upon interpregnancy intervals, but there has been little discussion of their potential impact upon racial disparities in health outcomes. The purpose of this study was to assess the impact of the Medicaid Family Planning Waiver (FPW) Program on Black-White disparities in pregnancy outcomes. STUDY DESIGN: Linked birth files for Black and White teens (!20 years) with Florida Medicaid-funded births in 1999 were examined to determine the rate of subsequent births within two years. Results were stratified by race and presence of a Medicaid FP-related claim. Calculations of ‘‘averted’’ and ‘‘potentially averted’’ births and ‘‘averted’’ and ‘‘potentially averted’’ very low birth weight (VLBW) births were subsequently performed. RESULTS: While black and white teens had similar rates of Medicaid FP claims, as compared to non-users of FP services, Black FP users had a greater reduction in rates of subsequent births within two years of an index pregnancy than did Whites (34% vs. 16% reduction, P ! .001). This held true for teens that would have lost Medicaid eligibility postpartum as well as for extremely poor teens that would have retained Medicaid eligibility. In the presence of use of FP, racial disparities in short interpregnancy intervals were eliminated. There were a greater number of ‘‘averted’’ and ‘‘potentially averted’’ total and VLBW births amongst Black teens (RR 2.66–9.76, P ! .001). CONCLUSION: Providing interconception care and FP services through programs like the Medicaid FPW may have different effects upon health outcomes amongst Black women as compared to White women. Improving access to care and baseline health status of women prior to pregnancy is likely to reduce some of the racial disparities in pregnancy outcomes. 351 PREDICTION OF THE LATENCY PERIOD BY CERVICAL LENGTH IN PRETERM PREMATURE RUPTURE OF MEMBRANES ACQUINONETTE BRYANT 1 , TAMMY SINCLAIR 1 , AMY MURTHA 1 , 1 Duke University Medical Center, Obstetrics and Gynecology, Durham, North Carolina OBJECTIVE: Preterm premature rupture of membranes (PPROM) remains a leading cause of preterm delivery. The interval from rupture of membranes to delivery is important in optimizing neonatal outcomes. However, predicting the latency period remains a challenge in obstetric practice. The objective of this study is to determine if the cervical length in pregnant women diagnosed with (PPROM) is associated with a decrease in latency period. The secondary objective is to determine if cervical length is associated with an increase in the incidence of funisitis. STUDY DESIGN: The ultrasound reports of women, whom were previously recruited in the PPROM Infection & Inflammation study, were reviewed; and data regarding the cervical length and the mode of ultrasound was collected. All subjects admitted with the diagnosis from 22-34 weeks were approached for enrollment. All subjects received an ultrasound as part of their routine care. The latency period was defined in hours from the time of rupture to the time of delivery. The cervical lengths were divided into two groups: > or %2.5 cm. The latency period between the two groups was compared using the Mann-Whitney U test. The cervical length and incidence of funisitis was compared using the t test. RESULTS: Of the 112 patients enrolled 24% had cervical length %2.5 cm. A cervical length of %2.5 cm was associated with a significant decrease in the median latency compared to those >2.5 cm (142.8 hours versus 290.9 hours, P = .002). 37% (37/102) of the patients enrolled had a histological diagnosis of funisitis. The mean cervical length in patients with funisitis was 3.44 cm compared to 3.05 cm in those without funisitis (P = .64). CONCLUSION: In women with PPROM the latency period appears to be shorter in patients with a cervical length %2.5 cm. Preliminary analysis suggests that cervical length may not predict funisitis. 352 INTRAUTERINE INFLAMMATION RESULTS IN DIVERGENT TH1/TH2 RESPONSES BETWEEN THE FETUS AND FETAL BRAIN MICHAL ELOVITZ 1 , CONJEEVARAM MRINALINI 2 , 1 University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, Pennsylvania, 2 University of Pennsylvania, CRRWH, Philadelphia, Pennsylvania OBJECTIVE: The presence of intrauterine inflammation in a preterm birth increases the risk for adverse neurological outcomes as manifested by PVL, IVH and/or cerebral palsy. One of the proposed mechanisms by which brain injury occurs in these preterm neonates is via activation of a systemic fetal in- flammatory response. These studies sought to elucidate the TH1/TH2 response in the fetus and fetal brain in response to intrauterine inflammation. STUDY DESIGN: On D15 of gestation, CD-1 mice were randomized to receive either intrauterine saline or lipopolysaccharide (LPS) into the right uterine horn. Six hours later, fetal pups were harvested from the left upper horn. RNA was harvested from fetal bodies and brains. For increase sensitivity, MGB conjugated primers were utilized for quantitatve PCR. 16 genes involved in the TH1/TH2 response were investigated, with 3-6 samples per treatment group. Statistical analysis was performed with t test or Mann-Whitney rank sum. RESULTS: In the fetus proper, 11/16 genes investigated were significantly up- regulated. In contrast, in the brain, intrauterine LPS promoted a signficant up- regulation of all TH1 and TH2 genes investigated. The classic TH1 cytokines, IL-1 and TNF were more profoundly elevated in the fetal brain than in the fetus proper. While Il-2, a key TH1 cytokine, was elevated 6.5-fold in the fetus and 2- fold in the brain. TH2 cytokines, IL-10, IL-13 and IL-4 were signficantly increased in the fetal brains exposed to LPS (3.7, 18 and 5.5-fold) while only IL-10 and Il-4 were increased in the fetus. CONCLUSION: Intrauterine inflammation activates a diverse and potent immune response in the fetal brain and to a lesser extent in the fetus proper. Using a sensitive PCR technique, characterization of these responses demon- strates distinct differences in the cytokines produced in the fetus compared to the brain in response to intrauterine LPS. Future studies are warranted to determine if cytokines generated in the fetus are merely an epiphenomena or are in fact, essential for triggering an inflammatory response in the brain. S104 SMFM Abstracts
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Transcript of Impact of the Medicaid Family Planning Waiver on Black-White disparities in pregnancy outcomes...
349 SERUM PROTEOMIC SCREENING USING SELDI-TOF TO DETECT BIOMARKERS FORPRETERM LABOR JAY BOLNICK1, CHARLOTTE MOBARAK2, VIRGINIA SEVERNS3,MARIA VELAZQUEZ1, CHEN MENG4, KIMBERLY LESLIE1, 1University of NewMexico, Obstetrics and Gynecology, Albuquerque, New Mexico, 2Universityof New Mexico, Basic Med Sciences, Albuquerque, New Mexico, 3University ofNew Mexico, Albuquerque, New Mexico, 4University of New Mexico,Psychology, Albuquerque, New Mexico
OBJECTIVE: To derive an initial proteomic serum screening test to discrim-inate patients with preterm labor from controls which will form the basis forfuture large-scale validation studies.
STUDY DESIGN: To derive an initial algorithm that is sensitive and specific forpreterm labor, 28 women between 24 and 34 gestational weeks were recruited todonate serum samples. Fourteen women were in preterm labor with progressivecervical dilatation and effacement and with painful regular uterine contractions.Fourteen gestational-age matched controls delivered at R37 weeks. Serumsamples were collected and immediately frozen at �80 degrees C. Samples thenunderwent fractionization according to pH (range from 9 to 1 pH units) to allowmore sensitivity to identify proteins of low abundance. Samples were thensubjected to surface enhanced laser desorption and ionization - time of flight(SELDI-TOF) analysis using the IMAC30 (copper metal affinity) CiphergenProteinChip Array. Spectra were acquired and analyzed using CiphergenProteinChip and Biomarker Patterns software and proprietary programsmaintained at our institution.
RESULTS: There were statistically significant changes in multiple peptidepeaks across fractions in samples from patients with preterm labor compared tocontrols. Between six and 10 peaks were used to derive predictive algorithmswith sensitivities ranging from 72-98% and specificities ranging from 73-86% foreach fraction. The best peaks from multiple fractions will now be combined toproduce the most predictive algorithm for validation.
CONCLUSION: It is possible to derive specific and sensitive algorithmscorrelating with distinct proteomic profiles in patients with preterm laborcompared to controls. These initial investigations will form the basis of largerstudies for the refinement of predictive peaks and validation. Current studies arealso ongoing to determine the identity of the discriminating proteins.
351 PREDICTION OF THE LATENCY PERIOD BY CERVICAL LENGTH IN PRETERMPREMATURE RUPTURE OF MEMBRANES ACQUINONETTE BRYANT1,TAMMY SINCLAIR1, AMY MURTHA1, 1Duke University Medical Center, Obstetricsand Gynecology, Durham, North Carolina
OBJECTIVE: Preterm premature rupture of membranes (PPROM) remainsa leading cause of preterm delivery. The interval from rupture of membranes todelivery is important in optimizing neonatal outcomes. However, predicting thelatency period remains a challenge in obstetric practice. The objective of thisstudy is to determine if the cervical length in pregnant women diagnosed with(PPROM) is associated with a decrease in latency period. The secondaryobjective is to determine if cervical length is associated with an increase in theincidence of funisitis.
STUDY DESIGN: The ultrasound reports of women, whom were previouslyrecruited in the PPROM Infection & Inflammation study, were reviewed; anddata regarding the cervical length and the mode of ultrasound was collected. Allsubjects admitted with the diagnosis from 22-34 weeks were approached forenrollment. All subjects received an ultrasound as part of their routine care. Thelatency period was defined in hours from the time of rupture to the time ofdelivery. The cervical lengths were divided into two groups: > or %2.5 cm. Thelatency period between the two groups was compared using the Mann-WhitneyU test. The cervical length and incidence of funisitis was compared using thet test.
RESULTS: Of the 112 patients enrolled 24% had cervical length %2.5 cm. Acervical length of %2.5 cm was associated with a significant decrease in themedian latency compared to those >2.5 cm (142.8 hours versus 290.9 hours,P = .002). 37% (37/102) of the patients enrolled had a histological diagnosis offunisitis. The mean cervical length in patients with funisitis was 3.44 cmcompared to 3.05 cm in those without funisitis (P = .64).
CONCLUSION: In women with PPROM the latency period appears to beshorter in patients with a cervical length %2.5 cm. Preliminary analysis suggeststhat cervical length may not predict funisitis.
352 INTRAUTERINE INFLAMMATION RESULTS IN DIVERGENT TH1/TH2 RESPONSESBETWEEN THE FETUS AND FETAL BRAIN MICHAL ELOVITZ1, CONJEEVARAMMRINALINI2, 1University of Pennsylvania, Obstetrics and Gynecology,Philadelphia, Pennsylvania, 2University of Pennsylvania, CRRWH,Philadelphia, Pennsylvania
OBJECTIVE: The presence of intrauterine inflammation in a preterm birthincreases the risk for adverse neurological outcomes as manifested by PVL, IVHand/or cerebral palsy. One of the proposed mechanisms by which brain injuryoccurs in these preterm neonates is via activation of a systemic fetal in-flammatory response. These studies sought to elucidate the TH1/TH2 responsein the fetus and fetal brain in response to intrauterine inflammation.
STUDY DESIGN: On D15 of gestation, CD-1 mice were randomized to receiveeither intrauterine saline or lipopolysaccharide (LPS) into the right uterine horn.Six hours later, fetal pups were harvested from the left upper horn. RNA washarvested from fetal bodies and brains. For increase sensitivity, MGBconjugated primers were utilized for quantitatve PCR. 16 genes involved inthe TH1/TH2 response were investigated, with 3-6 samples per treatment group.Statistical analysis was performed with t test or Mann-Whitney rank sum.
RESULTS: In the fetus proper, 11/16 genes investigated were significantly up-regulated. In contrast, in the brain, intrauterine LPS promoted a signficant up-regulation of all TH1 and TH2 genes investigated. The classic TH1 cytokines,IL-1 and TNF were more profoundly elevated in the fetal brain than in the fetusproper. While Il-2, a key TH1 cytokine, was elevated 6.5-fold in the fetus and 2-fold in the brain. TH2 cytokines, IL-10, IL-13 and IL-4 were signficantlyincreased in the fetal brains exposed to LPS (3.7, 18 and 5.5-fold) while onlyIL-10 and Il-4 were increased in the fetus.
CONCLUSION: Intrauterine inflammation activates a diverse and potentimmune response in the fetal brain and to a lesser extent in the fetus proper.Using a sensitive PCR technique, characterization of these responses demon-strates distinct differences in the cytokines produced in the fetus compared to thebrain in response to intrauterine LPS. Future studies are warranted to determineif cytokines generated in the fetus are merely an epiphenomena or are in fact,essential for triggering an inflammatory response in the brain.
S104 SMFM Abstracts
350 IMPACT OF THE MEDICAID FAMILY PLANNING WAIVER ON BLACK-WHITEDISPARITIES IN PREGNANCY OUTCOMES AMONGST TEENS IN THE STATE OFFLORIDA ALLISON BRYANT1, MAGDA PECK2, JENNIFER SKALA2, PAUL WISE3,1Brigham and Women’s Hospital, Division of Maternal Fetal Medicine, Boston,Massachusetts, 2CityMatch at the University of Nebraska, Omaha, Nebraska,3Brigham and Women’s Hospital, Divison of Social Medicine and HealthInequalities, Boston, Massachusetts
OBJECTIVE: Eighteen states, including Florida, have implemented MedicaidFPWs, providing family planning (FP) and primary care services to women whowould otherwise lose Medicaid coverage. Such programs have been evaluated forbudget-neutrality and effects upon interpregnancy intervals, but there has beenlittle discussion of their potential impact upon racial disparities in healthoutcomes. The purpose of this study was to assess the impact of the MedicaidFamily Planning Waiver (FPW) Program on Black-White disparities inpregnancy outcomes.
STUDY DESIGN: Linked birth files for Black and White teens (!20 years) withFlorida Medicaid-funded births in 1999 were examined to determine the rate ofsubsequent births within two years. Results were stratified by race and presenceof a Medicaid FP-related claim. Calculations of ‘‘averted’’ and ‘‘potentiallyaverted’’ births and ‘‘averted’’ and ‘‘potentially averted’’ very low birth weight(VLBW) births were subsequently performed.
RESULTS: While black and white teens had similar rates of Medicaid FPclaims, as compared to non-users of FP services, Black FP users had a greaterreduction in rates of subsequent births within two years of an index pregnancythan did Whites (34% vs. 16% reduction, P! .001). This held true for teens thatwould have lost Medicaid eligibility postpartum as well as for extremely poorteens that would have retained Medicaid eligibility. In the presence of use of FP,racial disparities in short interpregnancy intervals were eliminated. There werea greater number of ‘‘averted’’ and ‘‘potentially averted’’ total and VLBW birthsamongst Black teens (RR 2.66–9.76, P ! .001).
CONCLUSION: Providing interconception care and FP services throughprograms like the Medicaid FPW may have different effects upon healthoutcomes amongst Black women as compared to White women. Improvingaccess to care and baseline health status of women prior to pregnancy is likely toreduce some of the racial disparities in pregnancy outcomes.
