178: Effect of omega-3 supplementation on plasma fatty acid levels
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178 EFFECT OF OMEGA-3 SUPPLEMENTATION ON PLASMA FATTY ACID LEVELS MARGARET HARPER 1 , 1 for the Eunice Kennedy Shriver National Institute of Child Health and Human Development MFMU Network, Bethesda, Maryland OBJECTIVE: Daily omega-3 fatty acid (FA) supplementation, eicosapentaenoic acid (EPA,1200 mgs) and docosahexaenoic acid (DHA, 800 mgs), offered no pro- tection from recurrent preterm delivery in a randomized placebo-controlled trial of high risk women receiving weekly 17 alpha-hydroxyprogesterone caproate. In- creased levels of EPA and DHA can reduce the production of the potent 2-series prostaglandins derived from arachidonic acid (AA). We conducted this analysis to determine if the supplement altered plasma levels of EPA, DHA or AA. STUDY DESIGN: Blood was collected at enrollment (16-21 weeks’ gestation) and again at 25-28 weeks’ gestation. Plasma was separated, snap frozen and stored at - 70 degrees at a central laboratory until FA determination by gas chromatography. Results were reported as percent of total FA. Wilcoxon test was used to compare the mean change (level at 25-28 weeks minus level at enrollment) in FA between the omega-3 and placebo groups. RESULTS: Of 852 primary study participants, 512 (261 in the omega-3 group and 251 in the placebo group) had results of FA analysis from both enrollment and 25-28 weeks. The mean change in level of EPA, DHA and AA were significantly different between the omega-3 and placebo groups. (Figure) Mean change in plasma levels as % total FA CONCLUSION: Omega-3 supplementation raised EPA and DHA and lowered AA levels in pregnancy. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.205 179 FAILURE OF CERVICAL RIPENING WITH PGE2 – CAN IT BE PREDICTED? NIR MELAMED 1 , AVI BEN-HAROUSH 1 , RONY CHEN 1 , BORIS KAPLAN 1 , MOSHE HOD 1 , YARIV YOGEV 1 , 1 Helen Schneider Hospital for Women, Obstetrics and Gynecology, Tel Aviv, Israel, Israel OBJECTIVE: Limited data exists concerning risk factors for ripening failure us- ing PGE2. Thus, we aimed to identify which factors are associated with cervical ripening failure using vaginal PGE2 tablets STUDY DESIGN: A case control retrospective study. Study group included all women admitted for cervical ripening with unfavorable Bishop’s score (7) be- tween January 2003 and December 2007 and failed to respond to cervical ripening using PGE2 vaginal tablets (no change in Bishop’s score after 5 applications of PGE2, 6-8 hours apart). A cohort of women who underwent successful cervical ripening with vaginal PGE2 in the same time period in a 3:1 served as the control group. All women were treated by the same protocol. RESULTS: 1. overall 488 women were included of them 122 in the research group and 366 in the control group. 2. A comparison between the two groups has revealed that maternal age 30 years (OR2.7, 95%-CI 1.3-5.6), nulliparity (OR4.1, 95%-CI 1.7-10.0), pre-pregnancy BMI 25 (OR3.5, 95%-CI 1.7-7.1), cervical dilatation 1 cm at admission (OR9.1, 95%-CI 3.5-13.4), cervical efface- ment 50% at admission (OR5.0, 95%-CI 2.2-8.8) and gestational age 37 weeks (OR2.9, 95%-CI 1.3-6.6), were independently and significantly associated with cervical ripening failure with PGE2. 3. The prediction model based on these factors accounts for almost 50% of the cervical ripening failure outcome (R2 0.47). 4. No significant association was found between cervical ripening failure and indication for ripening, rupture of membranes, weight gain during pregnancy, diabetes or preeclampsia during pregnancy, and birthweight. CONCLUSION: This novel study identifies risk factors for ripening failure with PGE2. Characterization of women who have high probability for cervical ripening failure with PGE2 will help to improve the consultation prior to induction and may help to choose the optimal method for labor induction in these cases. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.206 180 CYTOKINE PROFILING: VARIATION IN IMMUNE MODULATION IN ADVERSE VERSUS UNCOMPLICATED OBSTETRICAL OUTCOMES JEFF DENNEY 1 , EDWARD NELSON 2 , THADDEUS WATERS 3 , PATHICK WADWA 4 , LENY MATHEW 5 , ROBERT GOLDENBERG 6 , JENNIFER CULHANE 5 , 1 University of Utah, Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Salt Lake City, Utah, 2 University of Califor- nia, Irvine, Department of Medicine, Division of Hematology/Oncology, Orange, California, 3 MetroHealth Medical Center - Case Western Reserve University, Cleveland, Ohio, 4 University of California, Irvine, Department of Obstetrics & Gynecology, California, 5 Children’s Hospital of Philadelphia, Department of Pedi- atrics, Division of Adolescent Medicine, Philadelphia, Pennsylvania, 6 Drexel Uni- versity College of Medicine, Department of Obstetrics & Gynecology, Center for Perinatal Research, Philadelphia, Pennsylvania OBJECTIVE: To assess if deviations in longitudinally measured cytokines are associated with development of adverse pregnancy outcomes. STUDY DESIGN: This is a prospective longitudinal study of maternal cytokines over pregnancy. Women 17 years old with a singleton gestation at 15 weeks were enrolled. Peripheral blood was collected at 8-14 (T1), 18-22 (T2), and 28-32 (T3) weeks gestational age. Using Luminex-100 MAP®, 6 cytokines—IL-1, IFN-, IL-4, IL-6, IL-10, and TNF-—were measured from whole blood incubated in three conditions: unstimulated, PHA-stimulated, and LPS-stimulated. Data were stratified into two groups based upon pregnancy outcomes: “Uncomplicated” (de- livered at or beyond 37 weeks) or “Adverse” (defined as a delivery 37 weeks gestational age or BW 2500g). Using Generalized Linear Modeling, we deter- mined the rate of change for each cytokine from T1 to T3. An Interaction term of group with gestational age was used to compare the rates of change by pregnancy outcome. Differences were defined as significant at the 95% level. RESULTS: 32 women with Adverse obstetrical outcomes were compared to 11 women with Uncomplicated outcomes. In both Adverse and Uncomplicated groups, TH1 cytokine (IL-1), pleiotrophic pro-inflammatory cytokine (IL-6), and counter-regulatory cytokine (IL-10) responses decreased over the course of gesta- tion. However, the rates of change in IL-1, IL-6, and IL-10 were significantly different; see table. For other cytokines, trajectories did not vary significantly be- tween the groups. CONCLUSION: Women with a PTB or LBW newborn demonstrated significant differences in cytokine trajectory over pregnancy. This supports existing data on the importance of immunoregulation in pregnancy. Significantly Different Cytokine Trajectories Uncomplicated (-coefficient) Adverse (- coefficient) p-value IL-1-PHA 0.035 0.007 0.004 IL-6-control 0.009 0.051 0.018 IL-10-control 0.011 0.059 0.045 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.207 181 MODE OF DELIVERY AND NEONATAL RESPIRATORY MORBIDITY IN NEAR-TERM PRETERM BIRTHS CAITLIN SAINT-AUBIN 1 , SARAH HOPKINS 1 , DEBORAH FELDMAN 1 , VICTOR FANG 1 , CHARLES INGARDIA 1 , ADAM BORGIDA 1 , 1 Hartford Hospital, Hartford, Connecticut OBJECTIVE: We reviewed respiratory complications for near-term (34 to 36 weeks) preterm births (PTB) at our institution based on mode of delivery. STUDY DESIGN: We performed a retrospective cohort analysis of our hospital=s perinatal and neonatal databases to identify all singleton near-term PTBs from 1998 to 2006. We compared respiratory complications for babies admitted to the NICU by mode of delivery. RESULTS: There were 2,222 near-term PTBs during the study period with 715 (32%) NICU admissions. The overall cesarean rate was 43%. There were signifi- cantly more short-term respiratory complications for those babies born by cesar- ean, as shown in the table. CONCLUSION: Recently, studies have reported an increasing rate of neonatal respiratory morbidity in near-term PTBs. The increased risk was attributed to the changing mode of delivery with an increasing cesarean rate. Our findings provide further evidence that mode of delivery significantly affects short-term neonatal respiratory complications. Respiratory Morbidity Morbidity Vaginal Birth n407 Cesarean Birth n308 p Mechanical Ventilation 15.2% 25% .001 Oxygen 39.3% 57.5% .0001 CPAP 36.4% 50.7% .0001 RDS 7.4% 11.4% .06 BPD 0.7% 2.0% .15 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.208 SMFM Abstracts www.AJOG.org S62 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
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SMFM Abstracts www.AJOG.org
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78 EFFECT OF OMEGA-3 SUPPLEMENTATION ON PLASMA FATTY ACIDLEVELS MARGARET HARPER1, 1for the Eunice Kennedy Shriver National Institute ofChild Health and Human Development MFMU Network, Bethesda, Maryland
OBJECTIVE: Daily omega-3 fatty acid (FA) supplementation, eicosapentaenoicacid (EPA,1200 mgs) and docosahexaenoic acid (DHA, 800 mgs), offered no pro-tection from recurrent preterm delivery in a randomized placebo-controlled trial ofhigh risk women receiving weekly 17 alpha-hydroxyprogesterone caproate. In-creased levels of EPA and DHA can reduce the production of the potent 2-seriesprostaglandins derived from arachidonic acid (AA). We conducted this analysis todetermine if the supplement altered plasma levels of EPA, DHA or AA.
STUDY DESIGN: Blood was collected at enrollment (16-21 weeks’ gestation) andagain at 25-28 weeks’ gestation. Plasma was separated, snap frozen and stored at - 70degrees at a central laboratory until FA determination by gas chromatography.Results were reported as percent of total FA. Wilcoxon test was used to compare themean change (level at 25-28 weeks minus level at enrollment) in FA between theomega-3 and placebo groups.
RESULTS: Of 852 primary study participants, 512 (261 in the omega-3 groupand 251 in the placebo group) had results of FA analysis from both enrollment and25-28 weeks. The mean change in level of EPA, DHA and AA were significantlydifferent between the omega-3 and placebo groups. (Figure)
Mean change in plasma levels as % total FA
CONCLUSION: Omega-3 supplementation raised EPA and DHA and loweredAA levels in pregnancy.
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.205
79 FAILURE OF CERVICAL RIPENING WITH PGE2 – CAN IT BE PREDICTED? NIRMELAMED1, AVI BEN-HAROUSH1, RONY CHEN1, BORIS KAPLAN1, MOSHE HOD1, YARIVYOGEV1, 1Helen Schneider Hospital for Women, Obstetrics and Gynecology, TelAviv, Israel, Israel
OBJECTIVE: Limited data exists concerning risk factors for ripening failure us-ing PGE2. Thus, we aimed to identify which factors are associated with cervicalripening failure using vaginal PGE2 tablets
STUDY DESIGN: A case control retrospective study. Study group included allwomen admitted for cervical ripening with unfavorable Bishop’s score (�7) be-tween January 2003 and December 2007 and failed to respond to cervical ripeningusing PGE2 vaginal tablets (no change in Bishop’s score after 5 applications ofPGE2, 6-8 hours apart). A cohort of women who underwent successful cervicalripening with vaginal PGE2 in the same time period in a 3:1 served as the controlgroup. All women were treated by the same protocol.
RESULTS: 1. overall 488 women were included of them 122 in the researchgroup and 366 in the control group. 2. A comparison between the two groups hasrevealed that maternal age � 30 years (OR�2.7, 95%-CI 1.3-5.6), nulliparity(OR�4.1, 95%-CI 1.7-10.0), pre-pregnancy BMI� 25 (OR�3.5, 95%-CI 1.7-7.1),cervical dilatation �1 cm at admission (OR�9.1, 95%-CI 3.5-13.4), cervical efface-ment � 50% at admission (OR�5.0, 95%-CI 2.2-8.8) and gestational age � 37weeks (OR�2.9, 95%-CI 1.3-6.6), were independently and significantly associatedwith cervical ripening failure with PGE2. 3. The prediction model based on thesefactors accounts for almost 50% of the cervical ripening failure outcome (R2 �0.47). 4. No significant association was found between cervical ripening failure andindication for ripening, rupture of membranes, weight gain during pregnancy,diabetes or preeclampsia during pregnancy, and birthweight.
CONCLUSION: This novel study identifies risk factors for ripening failure withPGE2. Characterization of women who have high probability for cervical ripeningfailure with PGE2 will help to improve the consultation prior to induction and mayhelp to choose the optimal method for labor induction in these cases.
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.206
62 American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2
80 CYTOKINE PROFILING: VARIATION IN IMMUNE MODULATION IN ADVERSE VERSUSUNCOMPLICATED OBSTETRICAL OUTCOMES JEFF DENNEY1, EDWARD NELSON2,THADDEUS WATERS3, PATHICK WADWA4, LENY MATHEW5, ROBERT GOLDENBERG6,JENNIFER CULHANE5, 1University of Utah, Department of Obstetrics & Gynecology,Division of Maternal-Fetal Medicine, Salt Lake City, Utah, 2University of Califor-nia, Irvine, Department of Medicine, Division of Hematology/Oncology, Orange,California, 3MetroHealth Medical Center - Case Western Reserve University,Cleveland, Ohio, 4University of California, Irvine, Department of Obstetrics &Gynecology, California, 5Children’s Hospital of Philadelphia, Department of Pedi-atrics, Division of Adolescent Medicine, Philadelphia, Pennsylvania, 6Drexel Uni-versity College of Medicine, Department of Obstetrics & Gynecology, Center forPerinatal Research, Philadelphia, Pennsylvania
OBJECTIVE: To assess if deviations in longitudinally measured cytokines areassociated with development of adverse pregnancy outcomes.
STUDY DESIGN: This is a prospective longitudinal study of maternal cytokinesover pregnancy. Women �17 years old with a singleton gestation at � 15 weekswere enrolled. Peripheral blood was collected at 8-14 (T1), 18-22 (T2), and 28-32(T3) weeks gestational age. Using Luminex-100 MAP®, 6 cytokines—IL-1�, IFN-�,IL-4, IL-6, IL-10, and TNF-�—were measured from whole blood incubated inthree conditions: unstimulated, PHA-stimulated, and LPS-stimulated. Data werestratified into two groups based upon pregnancy outcomes: “Uncomplicated” (de-livered at or beyond 37 weeks) or “Adverse” (defined as a delivery �37 weeksgestational age or BW �2500g). Using Generalized Linear Modeling, we deter-mined the rate of change for each cytokine from T1 to T3. An Interaction term ofgroup with gestational age was used to compare the rates of change by pregnancyoutcome. Differences were defined as significant at the 95% level.
RESULTS: 32 women with Adverse obstetrical outcomes were compared to 11women with Uncomplicated outcomes. In both Adverse and Uncomplicatedgroups, TH1 cytokine (IL-1�), pleiotrophic pro-inflammatory cytokine (IL-6), andcounter-regulatory cytokine (IL-10) responses decreased over the course of gesta-tion. However, the rates of change in IL-1�, IL-6, and IL-10 were significantlydifferent; see table. For other cytokines, trajectories did not vary significantly be-tween the groups.
CONCLUSION: Women with a PTB or LBW newborn demonstrated significantdifferences in cytokine trajectory over pregnancy. This supports existing data on theimportance of immunoregulation in pregnancy.
Significantly Different Cytokine Trajectories
Uncomplicated(�-coefficient)
Adverse (�-coefficient) p-value
IL-1�-PHA �0.035 �0.007 0.004IL-6-control �0.009 �0.051 0.018IL-10-control �0.011 �0.059 0.045
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.207
81 MODE OF DELIVERY AND NEONATAL RESPIRATORY MORBIDITY IN NEAR-TERMPRETERM BIRTHS CAITLIN SAINT-AUBIN1, SARAH HOPKINS1, DEBORAH FELDMAN1,VICTOR FANG1, CHARLES INGARDIA1, ADAM BORGIDA1, 1Hartford Hospital, Hartford,Connecticut
OBJECTIVE: We reviewed respiratory complications for near-term (34 to 36weeks) preterm births (PTB) at our institution based on mode of delivery.
STUDY DESIGN: We performed a retrospective cohort analysis of our hospital=sperinatal and neonatal databases to identify all singleton near-term PTBs from 1998to 2006. We compared respiratory complications for babies admitted to the NICUby mode of delivery.
RESULTS: There were 2,222 near-term PTBs during the study period with 715(32%) NICU admissions. The overall cesarean rate was 43%. There were signifi-cantly more short-term respiratory complications for those babies born by cesar-ean, as shown in the table.
CONCLUSION: Recently, studies have reported an increasing rate of neonatalrespiratory morbidity in near-term PTBs. The increased risk was attributed to thechanging mode of delivery with an increasing cesarean rate. Our findings providefurther evidence that mode of delivery significantly affects short-term neonatalrespiratory complications.
Respiratory Morbidity
Morbidity Vaginal Birth n�407 Cesarean Birth n�308 p
Mechanical Ventilation 15.2% 25% .001Oxygen 39.3% 57.5% �.0001CPAP 36.4% 50.7% .0001RDS 7.4% 11.4% .06BPD 0.7% 2.0% .15
0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.208
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