648: The impact of change in pregnancy body mass index on gestational hypertension/preeclampsia

Abstract

gestational hypertension/preeclampsia Morgan Swank, Aaron Caughey, Christine Farinelli, Elliott Main, Kathryn Melsop, William Gilbert, Judith Chung University of California, Irvine, Maternal Fetal Medicine, Orange, CA, Oregon Health & Science University, Maternal Fetal Medicine, Portland, OR, California Maternal Quality Care Collaborative, CMQCC, Stanford, CA, Sutter Medical Center, Maternal Fetal Medicine, Sacramento, CA OBJECTIVE: To examine the impact of changes in body mass index (BMI) during pregnancy on the incidence of gestational hypertension (GHTN)/preeclampsia (PRE). STUDY DESIGN: This is a retrospective cohort study using linked birth certificate and discharge diagnosis data (All-California, Rapid-Cycle, Maternal/Infant Database) from the year 2007. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated for the outcome of GHTN/PRE, as a function of a categorical change in pregnancy BMI: BMI loss (BMI change 0.5), no change ( 0.5 to 0.5), minimal (0.6 to 5), moderate (5.1 to 10), and excessive ( 10). No change in BMI served as the reference group. The impact of pregnancy change in BMI was determined for the entire cohort and then stratified by prepregnancy WHO BMI category. RESULTS: The study population consisted of 436,414 women with singleton gestations. Overall, women with excessive BMI change had a nearly two-fold increased incidence of GHTN/PRE, when compared to women with no net change in BMI (aOR 1.94; 95% CI 1.722.20). By prepregnancy BMI class, the aOR for GHTN/PRE in women with excessive BMI change were: normal weight (aOR 2.74, 95% CI, 1.87-4.04), overweight (aOR 3.43, 95% CI 2.62-4.94), obese class I (aOR 2.47, 95% CI 1.93-3.18), obese class II (aOR 2.53, 95% CI 1.84-3.48), obese class III (aOR 2.89, 95% CI 2.00-4.19). CONCLUSION: Regardless of prepregnancy BMI category, the aOR of developing GHTN/PRE was significantly higher in women with BMI change 10 when compared to women with no or minimal BMI change. Women who entered pregnancy in the overweight category (BMI 25.0-29.9) were at the greatest risk for developing hypertensive disorders with excessive BMI change. This may provide beneficial material for counseling patients of normal and overweight status, who are typically considered to be of a lower risk strata. Unadjusted incidence of gestational hypertension/preeclampsia as a function of change in pregnancy body mass index 649 PTX3, sFlt-1 and PlGF levels in mothers and their own newborn Paola Algeri, Sara Ornaghi, Davide Bernasconi, Fabrizio Cappellini, Stefano Signorini, Paolo Brambilla, Gabriele Urban, Patrizia Vergani University of Milan-Bicocca, Obstetrics and Gynaecology, Monza, Italy, University of Milan-Bicocca, Clinical medicine and Prevention, Center of Biostatistic for Clinical Epidemiology, Monza, Italy, University of MilanBicocca, Laboratory Medicine, Desio, Italy, University of Milan-Bicocca, Experimental Medicine, School of Medicine, Milan, Italy, University of Milan-Bicocca, Obstetrics and Gynaecology, Desio, Italy OBJECTIVE: An alteration of PTX3, sFlt-1 and PlGF serum levels is described during preeclampsia. Instead, no data about these markers in fetal serum are reported in literature. The aim of our study is to compare serum maternal and fetal markers’ levels in order to evaluate a potential relation between them. STUDY DESIGN: A case-control study with collection of 74 maternal serum samples and 74 fetal serum samples obtained from umbilical blood of each own baby. Samples were collected at time of delivery in 22 preeclamptic women and their newborns (cases), 23 women and their own babies, who formed a gestational age homogeneous group compared to cases (including pregnancies complicated by preterm delivery, IUGR and pPROM), and 29 healthy controls and their newborns (normal pregnancies delivered by elective cesarean section at 37 weeks). Statistical analysis was performed with Paired Wilcoxon test and Spearman correlation. RESULTS: Maternal and fetal levels of PTX3, sFlt-1 and PlGF were found to be different (p 0.0001 for each comparison). For each marker, the fetal level median was lower than the maternal one (PTX3: maternal median 1.78 ng/ml vs fetal median 1.11; sFlt-1: maternal median 5001.5 pg/ml vs fetal one 242.6; PlGF: maternal median 94.3 pg/ml vs fetal one 11.2).Table 1 shows Spearman correlation results: an independent trend for PTX3 in maternal versus fetal serum (p 0.14) was found, whereas maternal and fetal levels of sFlt-1 and PlGF presented a directly proportional relationship. CONCLUSION: Our results support a possible independent production of PTX3 in the fetus, whereas a trans-placental passage from mother to fetus is more likely to be the mechanism underlying fetal sFlt-1 and Demographics and miRNA levels between cases and controls