125 Pregnancies after assisted reproduction—Higher risk for adverse outcome
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$116 125 SMFM Abstracts PREGNANCIES AFI'ER ASSISTED REPRODUCTION--HIGHER RISK FOR ADVERSE OUTCOME UWE LANG t, JULIO HERRERO ], A BECK l, T STALF2, C MEHNERT 2, H GIPS2; lJus tus-Liebig-Univer sitar Giessen, Obstetrics and Gynecology, Giessen, Hessen; 2Institute of Reproductive Medicine Giessen, IVF, Giessen, Hessen OBJECTIVE: Pregnancies after assisted reproduction (IVF/ICSI) are considered to be risk pregnancies. The goal of our study was to assess whether and in which aspects the course of these pregnancies and perinatal outcome after [VF differ from pregnancies not conceived through assisted reproduc- tion. STUDY DESIGN: 406 pregnancies after IVF between 1994 and 1999 were examined. Data were compared with those of 338,737 patients without any form of sterility treatment from the statewide perinatal survey of the state of Hesse/ Germany (HEPE) for the same period. Additionally, within the IYT group, subgroups for PCO, hyperstimulation and other factors were formed and evaluated. RESULTS: 300 (73.9%) of the pregnancies after 1VF were singleton pregnancies, 97 (23.9%) twin pregnancies and 9 (2.2%) triplets. After grouping HEPE data for age and parity to match the IVF group, in singleton pregnancies we found a high late of early vaginal bleeding (1VF 15.7%; HEPE 2.5%; P< .05), PIH (IVF: 6.3 %; HEPE 2.1%; P< .05), gestational diabetes (IVF: 4.0%; HEPE 0.8%; P< .05), and premature labour (IVF: 25.7%; HEPE 7.3%; P < .05) in the 1VF group. Consequently pregnancies after 1VF had a high prematurity (IVF 20.3%; HEPE 6.7%; P< .05) and caesarean section late (IVF 35.7%; HEPE 19.9%; P< .05). Perinatal mortality in the IVF group was 1.0% (HEPE 0.6%). Furthermore, 16.8% of the newborns after IVF were growth restricted (HEPE 8.0%; P < .05); 4.4% were severely growth restricted (<3rd Percentile). Similar results were observed comparing twin pregnancies. Subgroups of IVF patients had even higher risks for e.g. gestational diabetes, hypertension and prematurity. Interestingly, impaired sperm morphology was associated with an increased IUGR late. CONCLUSION: Pregnancies after 1VF therapy are high risk pregnancies when compared to a standard collective (HEPE) matched for number of fetuses, age and parity. Subgroups of IVF patients show even higher rates of specific pregnancy risks, impaired sperm morphology seems to be linked to IUGR. 127 December 2001 AmJ Obstet Gynecol METOCLOPRAMIDE CONCENTRATION IN BREAST MILK OF WOMEN DELIVERING BETWEEN 23-34 WEEKS GESTATION WENDY HANSEN I, STEPHEN HUNTER 1, STEPHANIE MCANDREW ~, KATHLEEN HARRIS 3, BRIDGET ZIMMERMAN4; ÂUniversity of Iowa Hospitals and Clinics, Obstetrics and Gynecology, Iowa City, IA; 2University of Iowa Hospitals and Clinics, Iowa City, IA; 3University of Wisconsin Medical School, Madison, WI; 4University of Iowa College of Public Health, Biostatistics, Iowa City, IA OBJECTIVE: Metoclopramide (MC) is generally accepted to be an effective lactagogne. We determined the concentration of MC in the breast milk of women with preterm infants (23-34 weeks gestation). STUDY DESIGN: Breast milk samples were obtained from 14 mothers taking MC who delivered preterm infants. Subjects were chosen randomly from the experimental group (n = 34) of a larger randomized, double blind, placebo-controlled study (n = 69). Within 96 hours after birth, women took 10 mg of MC three times a day for 10 days. Breast milk samples were taken on day 10 -+ 2 and sent to National Medical Services (Willow Grove, PA) for a high- pressure liquid chromatography assay of the MC levels in the milk. All samples except one were extracted from a 24-hour collection of expressed breast milk. Breast milk samples from two mothers taking placebo were analyzed as controls. RESULTS: Breast milk assays of the two women in the placebo group did not detect MC. The mean level of MC excreted into the breast milk of the 14 subjects was 44.8 + 20.4 ng/mL. The median (25th-75th percentile) level of MC in breast milk was 45 (28-56) ng/mL. CONCLUSION: Mean levels of metocloplamide in preterm breast milk are similar to levels found in studies of term subjects. Breast milk levels are similar to the reported therapeutic range of 40-80 ng/mL in the plasma of adults taking 10 mg TID. We calculated the maximum possible exposure to infants in our study to be 0.011 mg/kg/day. This is about 3% of the recom- mended daily dosage (0.5 mg/kg/day) for children. This is similar to findings on term infants. 126 MATERNAL AGE AND RISK OF FETAL DEATH IN TWIN GESTATIONS IN THE UNITED STATES JOSEPH CANTERINO t, CANDE ANANTH 2, JOHN SMULIAN2, JOHN HARRIGAN 3, ANTHONY VINTZILEOS2; i UMDNJ-Rober t Wood Johnson Medical School/Saint Peter's University Hospital, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, NJ; 2UMDNJRobert Wood Johnson Medical School/Saint Peter's University Hospital, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, NJ; 3Jersey Shore Medical Center, Maternal-Fetal Medicine, Neptune, NJ OBJECTIVE: To evaluate the independent contributions of young and advanced naaternal age on fetal death in twin gestations and compare these risk profiles with other common indications for antepartom testing. STUDY DESIGN: Retrospective cohort analysis of twin gestataions between 1995-97 in the United States using linked birth-infant death data was performed. Gestational age <20 weeks and fetuses with anomalies were excluded. Fetal death rates with maternal ages 20-34 were compared with young (<20 years) and advanced age (35-39 years and _>40 years). Fetal death rates for common indications for antepartum testing including chronic hypertension (CHTN), pregnancy-induced hypertension (PIH), diabetes (DM), and small for gestational age (SGA) births were evaluated. Independent contributions of young and advanced ages, CHTN, PIH, DM and SGA births for the risk of fetal death were determined based on multivariable logistic regression models. Relative risk (RR) and 95% confidence intervals (CI) were derived from these models after adjusting for birth order, gravidity, race, marital status, prenatal care, education and smoking. RESULTS: Among the 275,901 births, fetal death occurred in 2,097 (0.8%). Fetal death rate and RR for maternal age categories, CHTN, PIH, DM and SGA are shown in the Table. When the analysis was restricted to delivery _>32weeks similiar risk profiles were noted. CONCLUSION: Young maternal age is independently associated with an increased risk for fetal death. The magnitude of these risks is similiar to those of other common indications for antepartum testing. Advanced maternal age appears to reduce the risk of fetal death. Table Fetal death rate in twin gestations GROUP TOTAL BIRTHS DEATHS (N) RATE RR (95% CI) <20 19,997 260 13.0 1.8 (1.5-2.0) 20-34 207,456 1,546 7.5 1.0 (Referent) 35-39 40,743 239 5.9 0.8 (0.7-0.9) >_40 7,705 52 6.7 0.9 (0.7-1.2) CHTN 2,462 22 8.9 1.2 (0.8-1.8) PIH 23,234 115 4.9 0.6 (0.5-0.8) DM 9,156 57 6.2 0.8 (0.6-1.1) SGA 25,050 620 24.8 4.3 (3.9-4.7) 128 THIRD-TRIMESTER UNEXPLAINED INTRAUTERINE FETAL DEATH IS NOT ASSOCIATED WITH THROMBOPI-UI.I& RONIT BECK-FRUCHTER t, YASSER HUJEIRAT 2, STAVIT SHALEV"2, ZOHAR NAHUM 1, AMIR WEISS 1, ZEEV WEINER t, ELIEZER SHALEV'3; tHa'Emek Medical Center, Obstetrics and Gynecology, Afnla; 2Ha'Emek Medical Center, Human Genetic Unit, Afula; 3Technion-Israel Institute of Technology, Rappaport Faculty of Medi- cine, Haifa OBJECTIVE: To determine the frequency of inherited and acquired thrombophilia among women with third-trimester unexplained intrauterine fetal death (IUFD). STUDY DESIGN: All women with IUFD after 24 weeks gestation in a 3-year period were initially assessed. Cases with congenital anomalies, intrauterine infection, feto-maternal bleeding or diabetes mellitus were excluded. The remaining 53 women were matched for ethnicity with 53 healthy women with a normal obstetrical history. All women, in both groups were tested for mutations of factor V Leiden, prothrombin gene, MTHFR, for the deficiencies of protein S, protein C, anti thrombin III and for lupus anticoagulant and anticardiolipin antibodies. RESULTS: The prevalence of any thrombophilia was 40% in the study group compared to 32% in the control group (P = .54). Inherited throm- bophilia was found in 32% of the study compared to 21% of controls (P= .27). The late of acquired thrombophilia did not differ between the groups (20% vs. 19%, respectively). The rate of combined thrombophilias was 15% vs. 7.5% (P = .36). CONCLUSION: Third-trimester unexplained IUFD is not associated with thrombophilia.
Transcript of 125 Pregnancies after assisted reproduction—Higher risk for adverse outcome
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SMFM Abstracts
PREGNANCIES AFI'ER ASSISTED REPRODUCTION--HIGHER RISK FOR ADVERSE O U T C O M E UWE LANG t, JULIO HERRERO ], A BECK l, T STALF 2, C MEHNERT 2, H GIPS2; lJus tus-Liebig-U niver sitar Giessen, Obstetrics and Gynecology, Giessen, Hessen; 2Institute of Reproductive Medicine Giessen, IVF, Giessen, Hessen
OBJECTIVE: Pregnancies af ter assisted r ep roduc t ion (IVF/ICSI) are considered to be risk pregnancies. The goal of our study was to assess whether and in which aspects the course of these pregnancies and perinatal outcome after [VF differ from pregnancies not conceived through assisted reproduc- tion.
STUDY DESIGN: 406 pregnancies after IVF between 1994 and 1999 were examined. Data were compared with those of 338,737 patients without any form of sterility t reatment from the statewide perinatal survey of the state of Hesse / Germany (HEPE) for the same period. Additionally, within the IYT group, subgroups for PCO, hyperstimulation and other factors were formed and evaluated.
RESULTS: 300 (73.9%) o f the pregnancies af ter 1VF were singleton pregnancies , 97 (23.9%) twin pregnancies and 9 (2.2%) triplets. After grouping HEPE data for age and parity to match the IVF group, in singleton pregnancies we found a high late of early vaginal bleeding (1VF 15.7%; HEPE 2.5%; P< .05), PIH (IVF: 6.3 %; HEPE 2.1%; P< .05), gestational diabetes (IVF: 4.0%; HEPE 0.8%; P< .05), and premature labour (IVF: 25.7%; HEPE 7.3%; P < .05) in the 1VF group. Consequent ly pregnanc ies af ter 1VF had a high prematuri ty (IVF 20.3%; HEPE 6.7%; P < .05) and caesarean section late (IVF 35.7%; HEPE 19.9%; P < .05). Perinatal mortality in the IVF group was 1.0% (HEPE 0.6%). Fur thermore , 16.8% of the newborns after IVF were growth restricted (HEPE 8.0%; P < .05); 4.4% were severely growth restricted (<3rd Percenti le) . Similar results were observed compar ing twin pregnancies . Subgroups of IVF patients had even higher risks for e.g. gestational diabetes, hypertension and prematurity. Interestingly, impaired sperm morphology was associated with an increased IUGR late.
CONCLUSION: Pregnancies after 1VF therapy are high risk pregnancies when c o m p a r e d to a s t andard collective (HEPE) ma tched for n u m b e r of fetuses, age and parity. Subgroups of IVF patients show even h igher rates of specific pregnancy risks, impaired sperm morphology seems to be linked to IUGR.
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December 2001 A m J Obstet Gynecol
METOCLOPRAMIDE CONCENTRATION IN BREAST MILK OF WOMEN DELIVERING BETWEEN 23-34 WEEKS GESTATION WENDY HANSEN I, STEPHEN HUNTER 1, STEPHANIE MCANDREW ~, KATHLEEN HARRIS 3, BRIDGET ZIMMERMAN4; ÂUniversity of Iowa Hospitals a n d Clinics, Obstetrics and Gynecology, Iowa City, IA; 2University of Iowa Hospitals and Clinics, Iowa City, IA; 3University of Wisconsin Medical School, Madison, WI; 4University of Iowa College of Public Health, Biostatistics, Iowa City, IA
OBJECTIVE: Metoclopramide (MC) is general ly accepted to be an effective lactagogne. We determined the concentra t ion of MC in the breast milk of women with pre term infants (23-34 weeks gestation).
STUDY DESIGN: Breast milk samples were obta ined f rom 14 mothers taking MC who delivered pre te rm infants. Subjects were chosen randomly f rom the experimental g roup (n = 34) of a larger randomized, double blind, placebo-controlled study (n = 69). Within 96 hours after birth, women took 10 mg of MC three times a day for 10 days. Breast milk samples were taken on day 10 -+ 2 and sent to National Medical Services (Willow Grove, PA) for a high- pressure liquid chromatography assay of the MC levels in the milk. All samples except one were extracted f rom a 24-hour collection of expressed breast milk. Breast milk samples f rom two mothers taking placebo were analyzed as controls.
RESULTS: Breast milk assays of the two women in the placebo group did not detect MC. The mean level of MC excreted into the breast milk of the 14 subjects was 44.8 + 20.4 n g / m L . The median (25th-75th percentile) level of MC in breast milk was 45 (28-56) ng /mL.
CONCLUSION: Mean levels of metocloplamide in pre term breast milk are similar to levels found in studies of term subjects. Breast milk levels are similar to the repor ted therapeutic range of 40-80 n g / m L in the plasma of adults taking 10 mg TID. We calculated the maximum possible exposure to infants in our study to be 0.011 mg /kg /day . This is about 3% of the recom- mended daily dosage (0.5 m g / k g / d a y ) for children. This is similar to findings on term infants.
126 MATERNAL AGE AND RISK OF FETAL DEATH IN TWIN GESTATIONS IN THE UNITED STATES JOSEPH CANTERINO t, CANDE ANANTH 2, J O H N SMULIAN2, J O H N HARRIGAN 3, ANTHONY VINTZILEOS2; i UMDNJ-Rober t Wood Johnson Medical School /Saint Peter's University Hospital, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, NJ; 2UMDNJRobert Wood Johnson Medical School/Saint Peter's University Hospital, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, NJ; 3Jersey Shore Medical Center, Maternal-Fetal Medicine, Neptune, NJ
OBJECTIVE: To evaluate the independen t contr ibutions of young and advanced naaternal age on fetal death in twin gestations and compare these risk profiles with other common indications for an tepar tom testing.
STUDY DESIGN: Retrospective cohor t analysis of twin gestataions between 1995-97 in the United States using linked birth-infant death data was pe r fo rmed . Gestational age <20 weeks a n d fetuses with anomal ies were excluded. Fetal death rates with maternal ages 20-34 were c o m p a r e d with young (<20 years) and advanced age (35-39 years and _>40 years). Fetal death rates for c o m m o n indicat ions for an t epa r tum testing inc luding chronic hyper tens ion (CHTN), p regnancy- induced hyper tens ion (PIH), diabetes (DM), and small for gestational age (SGA) births were evaluated. Independen t contributions of young and advanced ages, CHTN, PIH, DM and SGA births for the risk of fetal death were de te rmined based on multivariable logistic regression models. Relative risk (RR) and 95% confidence intervals (CI) were derived f rom these models after adjust ing for b i r th order, gravidity, race, marital status, prenatal care, education and smoking.
RESULTS: A m o n g the 275,901 births, fetal dea th occur red in 2,097 (0.8%). Fetal death rate and RR for maternal age categories, CHTN, PIH, DM and SGA are shown in the Table. When the analysis was restricted to delivery _>32 weeks similiar risk profiles were noted.
CONCLUSION: Young maternal age is independent ly associated with an increased risk for fetal death. The magni tude of these risks is similiar to those of other common indications for an tepar tum testing. Advanced maternal age appears to reduce the risk of fetal death.
Table Fetal death rate in twin gestations
G R O U P T O T A L B I R T H S DEATHS (N) RATE R R (95% CI)
<20 19,997 260 13.0 1.8 (1.5-2.0) 20-34 207,456 1,546 7.5 1.0 (Referent) 35-39 40,743 239 5.9 0.8 (0.7-0.9) >_40 7,705 52 6.7 0.9 (0.7-1.2) CHTN 2,462 22 8.9 1.2 (0.8-1.8) PIH 23,234 115 4.9 0.6 (0.5-0.8) DM 9,156 57 6.2 0.8 (0.6-1.1) SGA 25,050 620 24.8 4.3 (3.9-4.7)
128 THIRD-TRIMESTER UNEXPLAINED INTRAUTERINE FETAL DEATH IS N O T ASSOCIATED WITH THROMBOPI-UI.I& RONIT BECK-FRUCHTER t, YASSER HUJEIRAT 2, STAVIT SHALEV "2, ZOHAR NAHUM 1, AMIR WEISS 1, ZEEV WEINER t, ELIEZER SHALEV'3; tHa 'Emek Medical Center, Obstetrics a n d Gynecology, Afnla; 2Ha 'Emek Medical Center, H u m a n Genet ic Unit, Afula; 3Technion-Israel Institute of Technology, Rappapor t Faculty of Medi- cine, Haifa
OBJECTIVE: To de te rmine the f requency of inher i ted a n d acqu i red thrombophi l ia among women with third-trimester unexpla ined intrauterine fetal death (IUFD).
STUDY DESIGN: All women with IUFD after 24 weeks gestation in a 3-year per iod were initially assessed. Cases with congenital anomalies, intrauterine infection, fe to-maternal b leeding or diabetes mellitus were excluded. The remaining 53 women were matched for ethnicity with 53 healthy women with a no rma l obstetrical history. All women, in bo th groups were tested for mutations of factor V Leiden, p ro th rombin gene, MTHFR, for the deficiencies of protein S, prote in C, anti th rombin III and for lupus ant icoagulant and anticardiolipin antibodies.
RESULTS: The prevalence of any thrombophi l ia was 40% in the study g roup compared to 32% in the control g roup (P = .54). Inher i ted throm- bophil ia was found in 32% of the study compared to 21% of controls (P= .27). The late of acquired thrombophi l ia did not differ between the groups (20% vs. 19%, respectively). The rate of combined thrombophil ias was 15% vs. 7.5% (P = .36).
CONCLUSION: Third-trimester unexplained IUFD is not associated with thrombophilia.
