3rd Trimester Research Articles

Iron deficiency conditions prediction and prevention in children

The relevance of iron deficiency issues is due to the high frequency and tendency to steady growth, affecting the quality of life of the population. Pregnant, lactating women and young children are at high risk of developing iron deficiency conditions. Among pregnant women, a direct correlation was found between iron deficiency in the early stages of gestation and the pathological course of pregnancy and childbirth, lower indicators of physical, psychomotor development of children. Materials and methods. A prospective cohort study of 248 mother-child pairs was conducted. Pregnant, lactating women: the main group-women who received iron preparations during registration-106 persons, the comparison group-those who did not receive iron preparations-142. Inclusion criteria: absence of exacerbation of chronic pathology, allergic reactions, gastrointestinal pathology, infectious diseases. The women were examined at the end of the 3rd trimester and the postpartum period. Catamnestic observation was carried out for 248 children born to pregnant women. All children were observed with the informed consent of their parents. The duration of observation was up to a year. The children of the main group (106) and the comparison group (142) were singled out. Children of the main group on natural feeding (98) were divided into two subgroups. The first subgroup - 47 children whose mothers received iron preparations during lactation, the second subgroup - 51 children whose mothers did not receive iron subsidies. An assessment of the somatic status, a general clinical examination was carried out. Results and Discussion.Based on the data obtained using the statistical method of analysis, it was found that iron deficiency in the antenatal period significantly increased the frequency of premature birth, caused a deficiency of birth weight, heart disease, and led to a high frequency of viral infections in pregnant women. In newborns, from mothers who did not receive the iron preparation, a high frequency of latent iron deficiency (LID) and iron deficiency anemia (IDA) was noted. Newborns from the comparison group, according to the results of laboratory diagnostics, were treated with LID and IDA, however, lower indicators of physical development, NPR remained until 6 months. In the postnatal period, there was a direct correlation between the prophylactic intake of iron preparations by a nursing mother and the occurrence of latent iron deficiency and IDA in a child. Conclusion. The data obtained allow us to speak about the high effectiveness of preventive iron supplementation by a pregnant and lactating woman, to reduce the risk of pathological pregnancy and childbirth, affecting the indicators of physical and neuropsychic development (NPD) of a newborn and an infant. Even with the timely elimination of iron deficiency in a newborn, the delay in physical and NPR is noted up to 6 months. The analysis of the effect of iron deficiency in pregnant and nursing mothers on the course of the antenatal period, childbirth and the state of the child’s health dictates the need for prevention from the standpoint of a personalized approach.

Socio-Cultural Relations with K6 Visits to Pregnant Women Gestational Age > 36 Weeks

Socio-cultural is a custom carried out by someone from generation to generation based on trusted habits. One of them is the social culture in carrying out pregnancy checks according to standards known as K6 visits. Visits of K6 pregnant women are contacts of pregnant women with health workers to get ANC services according to the 10T standard, and the frequency of visits is at least six times during the gestation period, namely one time in the 1st trimester, two times in the 2nd trimester, and three times in the 3rd trimester. It aims to analyze socio-cultural relations with K6 visits. This study uses a research design analyst with a cross-sectional approach. Data were taken from interviews with respondents using questionnaires and observation sheets, carried out at the KIA Polyclinic at the Klenang Kidul Health Center on June 16 - August 22, 2022, with 30 respondents using accidental sampling. Data collection includes coding, editing, and tabulating, and then the data is analyzed manually and by computer testingChi-square. Of the 30 respondents studied, most were aged 20-35 years (50%), most of them had junior high school education (43.3%), most of them did not work (60%), the decision-makers in conducting pregnancy checks were pregnant women themselves (40 %), some are Madurese (70%), the majority are Muslim (100%), some respondents have one child (46.67%). The pregnancy status is mostly multigravida (46.67%). Most respondents were social and cultural (60%) and made K6 visits (53.3%). Data analysis in this study uses Uji Chi-Square with a value of α=0.05. The calculation results obtained a p-value < 0.05, namely 0.001 < 0.05, meaning there is a socio-cultural relationship with K6 visits at the Klenang Kidul Probolinggo Health Center. It is hoped that the Klenang Kidul Probolinggo Health Center will improve pregnancy check-up services according to the standards set by the government by providing counseling on the benefits of Antenatal Care as early as possible and not be affected by the existing social culture to reduce Maternal Mortality Rates and Infant Mortality Rates.

P-589 How Does Hypothyroidism Alter Perinatal Outcomes in Patients with Polycystic Ovary Syndrome? - An Evaluation of a Population Database

Abstract Study question Does concomitant hypothyroidism in polycystic ovary syndrome (PCOS) patients have an additive effect on the risk for adverse pregnancy, delivery and neonatal outcomes? Summary answer In patients with PCOS, hypothyroidism significantly increases the risk for preeclampsia, however risks of other adverse perinatal outcomes are unaltered. What is known already PCOS and hypothyroidism are common endocrinopathies during reproductive age, and each has been shown to be associated with pregnancy complications. While PCOS has been associated with gestational diabetes, gestational hypertension, and preeclampsia, overt hypothyroidism has been associated with pregnancy loss, intrauterine growth restriction, preeclampsia, and preterm birth. Furthermore, PCOS and thyroid abnormalities are known to be linked, with a higher prevalence of thyroid dysfunction in pregnant PCOS patients compared to controls. However, information on obstetric and neonatal outcomes in women with both PCOS and hypothyroidism is lacking. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. This population-based cohort study included 14,882 women with an International Classification of Diseases (ICD)-9 diagnosis of PCOS in the United States. IN 2015 data was converted to ICD-10 codes which are not comparable to ICD-9 codes. Participants/materials, setting, methods All pregnancy admissions that resulted in delivery or maternal death were included so that patients were counted only once per pregnancy. We compared PCOS women with a concurrent diagnosis of hypothyroidism to those without. Women with hyperthyroidism were excluded. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Multivariate logistic regression analysis was used to adjust for confounding effects. Main results and the role of chance Overall, 14,882 women met the inclusion criteria. Amongst them, 1,882 (12.65%) had a concomitant diagnosis of hypothyroidism, and 13,000 (87.35%) did not. Women with concomitant hypothyroidism, compared to those without, were characterized by increased maternal age (25.5% ≥35 years vs. 18%, p < 0.001, respectively), and had a higher rate of multiple gestations (7.1% vs. 5.7%, p = 0.023). Interestingly, pregnancy, delivery, and neonatal outcomes were comparable between the groups, except for a higher rate of small-for-gestational-age (SGA) neonates in the group with hypothyroidism (4.1% vs. 3.2%, p = 0.033), when not accounting for confounding effects. In a multivariate logistic regression adjusting for potential confounders, hypothyroidism was no longer found to be associated with SGA (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 0.99-1.75, p = 0.057), but was found to increase the odds for preeclampsia (aOR 1.30, 95% CI 1.06-1.59, p = 0.012). Of note when controlling for confounding effects, all other pregnancy, delivery, and neonatal outcomes were comparable between the groups, including pregnancy-induced hypertension; eclampsia; gestational diabetes mellitus; preterm premature rupture of membranes; preterm delivery; placental abruption; cesarean delivery; hysterectomy; post-partum hemorrhage; wound complications; maternal death; blood transfusions; maternal infection; venous thromboembolism; disseminated intravascular coagulation; SGA; intrauterine fetal death; and congenital anomalies. Limitations, reasons for caution Due to our study’s retrospective nature, some data is missing such as TSH levels, TPO antibody status, the time period in which hypothyroidism was diagnosed (pre-gestationally or during the 1st, 2nd or 3rd trimesters), and Levothyroxine treatment dose and compliance. Wider implications of the findings Patients with PCOS and hypothyroidism during pregnancy should be managed with consideration of instituting both preventive measures for preeclampsia development and heightened blood pressure, proteinuria, and symptom monitoring. Interestingly, hypothyroidism did little to affect the already increased rates of pregnancy complications in PCOS. This should be further studied. Trial registration number not applicable

Intrapartum and Postpartum Reactivation of Hepatitis B in Pregnant Patients: a multicentre study

Introduction: Changes in the immune system during pregnancy have been associated with reactivation of the hepatitis B virus in women chronic hepatitis B infection not receiving antiviral therapy. The aim of this study is to examine the development of intrapartum and postpartum hepatitis B reactivation in pregnant patients not being treated for chronic hepatitis B. Material and Methods: Pregnant women diagnosed with chronic hepatitis B and not receiving treatment between 2017 and 2022 in five centres in the east and southeast Turkey included in this study. In order to evaluate biochemical and viral reactivation from intrapartum and postpartum periods, patients with data for at least two periods were included in the study. Results: Evaluations were made on 171 pregnant women diagnosed with chronic hepatitis B. Reactivation occurred in 43 (25.2%) patients, in the postpartum period in 14 (32.35%) and in the intrapartum period in 29 (67.44%). Reactivation occurred most often in the 3rd trimester (n: 13, 30.2%). A significant increase was observed in the alanine aminotransferase levels of the patients with reactivation in the first trimester compared to 6 months prepartum and in the second trimester compared to the first trimester (p=0.038, p=0.039, respectively). The prepartum HBV DNA level (cut-off point =192 IU/ml) of patients with HBeAg negativity was found to have diagnostic power for reactivation of 0.684 (95% CI: 0.575-0.792, p=0.002) with 65.9% sensitivity and 68.6% specificity. Viral reactivation was observed in the first trimester in one patient and hepatitis B surface antibody was seen in the postpartum period. Conclusions: Asymptomatic viral reactivation occurred at the high rate of 25.1% in this series. To be able to identify reactivation as early as possible, pregnant patients should be followed up closely in the intrapartum and postpartum periods.

Predictive factors of weight at birth of newborns of adult women with pregestational Diabetes Mellitus : A retrospective observational study

AimsTo identify predictive factors of birth weight (BW) of newborns of women with pregestational diabetes mellitus (DM). MethodsRetrospective observational study with data from pregnant women who started prenatal nutritional monitoring up to 28 weeks, single pregnancy, and BW information. Quantitative variables were analyzed, and mean and standard deviation (SD) measures or medians and interquartile ranges (IQR) were calculated. Predictive factors were identified using multivariate linear regression. ResultsEighty-six pregnant women were analyzed, 50% were diagnosed with type 1 DM, 46.5% with type 2 DM, and 3.5% with unclassified DM; 41% were mixed black and white, 35.6% had overweight and 33.3% had pregestational obesity. The mean BW was 3313.93 g (SD = 696.08). The predictive factors identified were: gestational weight gain (GWG) at the 3rd trimester (ß=60.42; p = 0.04), and gestational age at delivery (ß=194.03; p < 0.001); adjusted by time of diagnosis of DM (p = 0.07) and 1st-trimester glycated hemoglobin (p = 0.71). ConclusionThe best predictors of BW were gestational age at birth and maternal anthropometric gestational characteristics, which are modifiable variables. The results may contribute to a review of the prenatal routines of pregnant women with DM.

The effect of e-cigarette taxes on prepregnancy and prenatal smoking.

E-cigarette taxes are an active area of legislation and have important regulatory implications by proxying e-cigarette accessibility. We examine the effect of e-cigarette taxes on prepregnancy and prenatal smoking using the near-universe of births to mothers conceiving between 2013 and 2019 in the United States. Using fixed effect regressions, we show that e-cigarette taxes increase prepregnancy and prenatal smoking. We also find evidence that e-cigarette taxes reduce prepregnancy and 3rd trimester e-cigarette use. Finally, we show that e-cigarette taxes increase news coverage of e-cigarettes and raise perceptions of risk of e-cigarettes.

280-OR: Metabolomic Signatures of Excess Fetal Growth in Pregnancies Complicated by Type 1 Diabetes (T1D)

Background: In pregnancies complicated by T1D, glycemic control is only moderately associated with excess fetal growth, suggesting that nutrients other than glucose may be involved. Aims: We analyzed associations between metabolites in maternal and newborn plasma, and fetal growth patterns, in T1D pregnancies. Methods: We obtained maternal plasma samples in the 2nd and 3rd trimester and at delivery, and cord blood samples immediately after delivery, in 22 mother/infant dyads. We used an untargeted metabolomic platform (Broad Institute) and calculated correlation coefficients between individual metabolites and newborn growth percentiles adjusted for gestational age, sex, parity, and ethnicity (GROW percentile). We used a false discovery rate threshold of FDR&amp;lt;0.2. Large for gestational age (LGA) was defined as GROW percentile ≥90 and appropriate for gestational age (AGA) as between the 10th and 90th percentiles. Results: Forty-five percent of newborns were classified as LGA. Maternal age, BMI, diabetes duration, insulin dose and pump use did not differ between LGA vs. AGA. We identified stronger associations between GROW percentiles and metabolites in cord blood than with metabolites in maternal plasma during the 2nd or 3rd trimester. In cord blood, 29 metabolites were associated with GROW percentile (FDR&amp;lt;0.2). For 51 metabolites, the ratio between abundance in cord blood to abundance in maternal blood at delivery was associated with the GROW percentile (FDR &amp;lt;0.2). Many of the top-ranking metabolites positively associated with infant growth were long-chain glycerophosphocholines (e.g., LPC(20:3) β 0.035, p=0.0002, FDR 0.01; LPC(22:5) β 0.033, p=0.0008, FDR 0.03). Conclusion: Glycerophospholipids in cord blood were associated with excess fetal growth in T1D pregnancies, suggesting alterations in lipid metabolism. We also report associations between fetal growth and ratios of metabolites in cord blood to maternal blood, suggesting differences in placental transport. Disclosure E.M.Isganaitis: None. D.Wolfs: None. J.C.O'connell: None. G.A.Hansbury: None. S.Wolpowitz: None. C.B.Clish: None. T.James-todd: None. F.M.Brown: Other Relationship; Dexcom, Inc. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK036836, P30DK057521); Broad Institute

1208-P: Modifiable Risk Factors during Pregnancy in Pregestational Diabetes—A 12-Year Analysis

Aim: Pregestational diabetes is associated with adverse outcomes. Preconception care is beneficial but unplanned pregnancy is common. We aimed to determine predictors of outcomes and factors modifiable during pregnancy in women with pregestational diabetes. Methods: Retrospective analysis of pregnancies complicated by pregestational diabetes at a tertiary center from 2010–2022. Baseline characteristics, longitudinal glycemic, weight and microvascular complication assessment per trimester, and outcomes were collected and binary logistic regression performed. Results: Of 445 pregnancies, 116 (25%) had type 1 diabetes. Mean age was 32.6 ± 5.8 years with prepregnancy BMI 30.0 ± 7.0 kg/m2. The cohort was diverse with 315 (71%) of non-Caucasian ethnicity and 141 (32%) in the most disadvantaged socioeconomic quintile. Planned pregnancy comprised 147 (43%). Women with type 1 compared to type 2 diabetes had increased preeclampsia (28 [26%] vs 48 [15%], p=0.02), preterm (46 [39%] vs 66 [20%], p&amp;lt;0.001), large for gestational age (LGA) (57 [49%] vs 82 [25%], p&amp;lt;0.001), neonatal hypoglycemia (53 [46%] vs 117 [37%], p=0.047), respiratory distress (47 [42%] vs 65 [20%], p&amp;lt;0.001) and neonatal intensive care admission (NICU) (48 [41%] vs 84 [26%], p=0.003). Small for gestational age was more common in type 2 diabetes (5 [4%] vs 32 [10%], p=0.045). Adjusting for diabetes type and baseline features, HbA1c&amp;gt;6.5% in 1st and &amp;gt;6% in 2nd and 3rd trimesters and &amp;gt;15% insulin decrease in 3rd trimester were associated with preeclampsia, 3rd trimester HbA1c&amp;gt;6% an independent predictor (OR 4.7) irrespective of 1st trimester HbA1c. Excessive gestational weight gain (GWG) (OR 3.4) and 3rd trimester HbA1c&amp;gt;6% (OR 3.6), irrespective of 1st trimester HbA1c, were independent predictors of LGA. Third trimester HbA1c&amp;gt;6% was associated with NICU (OR 3.7). Conclusion: Type 1 and 2 diabetes have distinct risk profiles for adverse outcomes. Early and late pregnancy glycemic control and GWG are modifiable targets during pregnancy. Disclosure Y.J.Rhou: None. N.Cheung: None. S.Padmanabhan: None.

172-OR: Normative CGM Glucose Levels throughout Gestation in Patients with Uncomplicated Pregnancies

Glycemic patterns throughout pregnancy are not well described, particularly early pregnancy. CGM used throughout the gestational period in uncomplicated pregnancies may help describe glycemic patterns in more detail. Blinded CGM data were collected throughout pregnancy from 760 pregnant patients ≥18 years old, with HbA1c &amp;lt;6.5%, no known diabetes, and gestational age &amp;lt;17 weeks. CGM data from uncomplicated pregnancies (pregnancy without gestational diabetes, large for gestational age birth, or hypertensive disorder of pregnancy) established the normative data set. Uncomplicated pregnancies (n=427, mean±SD age 32±4 years, 73% White non-Hispanic, mean HbA1c 5.1±0.3%) showed mean glucose during the entire gestational period was 99±7 mg/dL. Trimester specific mean glucose was: 103±7, 98±7 and 98±8 mg/dL for 1st, 2nd, 3rd trimesters. Figure 1 shows mean glucose by hour/trimester. Median (quartiles) percent time in range (TIR) 63-120 mg/dL was 86% (82-89%) for gestational period, and 84% (79-89%), 87% (82-90%), and 85% (80-90%) for 1st, 2nd, 3rd trimesters. Figure 2 shows TIR 63-120 mg/dL by 4-week periods. In uncomplicated pregnancies, mean glucose and TIR 63-120 mg/dL remained consistent throughout the gestational period. These normative CGM data will help set pregnancy-specific glycemic targets and will be important to compare to those 333 women in this study with complicated pregnancies. Disclosure A.L.Carlson: Advisory Panel; MannKind Corporation, Novo Nordisk, Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Medtronic, Novo Nordisk, Insulet Corporation, UnitedHealth Group, Sanofi. J.Sibayan: None. P.Calhoun: None. C.Durnwald: None. R.Beck: Consultant; Eli Lilly and Company, Novo Nordisk, Diasome, Insulet Corporation, Research Support; Tandem Diabetes Care, Inc., Beta Bionics, Inc., Dexcom, Inc., Bigfoot Biomedical, Inc., Medtronic, Ascensia Diabetes Care, Roche Diabetes Care, Eli Lilly and Company, Novo Nordisk. Z.Li: None. E.Norton: None. R.M.Bergenstal: Advisory Panel; Abbott Diabetes, Eli Lilly and Company, Medtronic, Novo Nordisk, Roche Diabetes Care, Zealand Pharma A/S, Consultant; Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Hygieia, Onduo LLC, Sanofi, Vertex Pharmaceuticals Incorporated, Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi, UnitedHealth Group. M.L.Johnson: Research Support; Abbott, Lilly, Insulet Corporation, NIH - National Institutes of Health, Patient-Centered Outcomes Research Institute, Novo Nordisk, Tandem Diabetes Care, Inc., Medtronic, Hemsley Charitable Trust, Jaeb Center for Health Research. S.Dunnigan: None. M.Banfield: None. K.J.Krumwiede: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust; United Health Group

180-LB: Associations of Phthalate Metabolites with Glycemic Parameters and Fetal Growth in Type 1 Diabetes (T1D) Pregnancies

Background: The risk of delivering a large for gestational age (LGA) infant is higher in pregnant individuals with T1D compared to individuals without diabetes, despite advances in managing T1D in pregnancy. Exposure to endocrine disrupting chemicals (e.g., phthalates) can affect both glucose homeostasis and fetal growth. Objective: To estimate associations of urinary phthalate metabolite levels with continuous glucose monitoring (CGM) data in pregnancy and birthweight. Methods: We analyzed urinary levels of 14 phthalate metabolites and derived trimester-specific CGM summary measures in 32 pregnant women with T1D. We estimated associations of log2-transformed urinary metabolite levels with continuous CGM outcomes and infant weight (GROW percentile) using linear regression, and estimated associations between metabolite levels and odds of LGA (GROW percentile ≥90) vs. AGA (&amp;lt;90) using logistic regression. Models were adjusted for maternal age and gestational week of study visit. Results: Participants were primarily white (85%), nulliparous (53%), with a mean age of 33 years, and 50% had LGA infants. Concentrations of mono-benzyl phthalate (mBzP) and mono-carboxy octyl phthalate (mCNP), were associated with glycemia in the 3rd trimester. Specifically, each doubling of mBzP and mCNP concentration was associated with 8.5 mg/dL (95% CI: 1.4, 15.6) and 8.9 mg/dL (-1.3, 19.0) higher average glucose, -6.0% (-10.9, -1.0) and -8.9% (-15.1, -2.7) less time spent in range (63-140mg/dL), and 5.9% (0.7, 11.2) and 7.4% (0.3, 14.5) more time spent above range (&amp;gt;140 mg/dL). Phthalates were not associated with continuous GROW percentile. Conclusion: Exposure to certain phthalates in later pregnancy may affect glycemic control in pregnant individuals with T1D. However, effects of phthalate exposure on birthweight are unclear. Future studies may disentangle the extent to which phthalate exposure and its effects on glycemic control may impact fetal growth. Disclosure E. V. Preston: None. F. M. Brown: Other Relationship; Dexcom, Inc. G. A. Hansbury: None. J. C. O'connell: None. D. Wolfs: None. J. Dreyfuss: None. S. Wolpowitz: None. Z. Wang: None. T. James-todd: None. E. M. Isganaitis: None. Funding National Institute of Environmental Health Sciences; National Institute of Diabetes and Digestive and Kidney Diseases

175-OR: Pregnancy Intervention with a Closed-Loop System (PICLS) Study

We performed a parallel, two-site, randomized controlled trial of a commercially available hybrid closed-loop (HCL) system compared to sensor augmented pump therapy (SAPT) in pregnant women with type 1 diabetes (T1D). Participants started SAPT (Medtronic 670G) by 11 weeks gestation, were randomized at 14-18 weeks, and continued therapy until 6 weeks postpartum. The HCL group used assistive techniques, “fake carbohydrate” boluses, to optimize therapy. We performed linear mixed model regression to compare outcomes between groups, adjusted for clinic. There were 24 women randomized and 23 completers. At baseline there were no significant differences between groups (mean baseline A1C 6.8% at 8w5d [SAPT]/9w0d [HCL] enrollment). There were no episodes of severe hypoglycemia or diabetic ketoacidosis after randomization. Adverse skin reactions occurred in 6 participants (5 SAPT vs 1 HCL, p=0.1550) with a median (IQR) number of 1 (1-2) SAPT vs 4 (4-4) HCL (p=0.8774). A1C significantly decreased from baseline to 2nd trimester, and was different between groups in the 3rd trimester (Table 1). There were no differences in time below, within, or above range between groups during the study (Table 1) or in gestational health outcomes (Table 2). In a pilot cohort of pregnant women with T1D, assisted HCL therapy did not increase risk to mothers or fetuses compared to SAPT despite lack of a pregnancy-specific algorithm in the HCL system. Disclosure E.Buschur: Consultant; Beta Bionics, Inc., Research Support; Dexcom, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust. E.R.Nease: None. S.Polsky: Other Relationship; diaTribe, Research Support; Dexcom, Inc., Medtronic, Hemsley Charitable Trust, JDRF, NIH - National Institutes of Health. J.K.Snell-bergeon: None. L.Pyle: None. R.Garcetti: None. K.M.Dungan: Board Member; Elsevier, Consultant; Eli Lilly and Company, Dexcom, Inc., Other Relationship; UpToDate, Research Support; Dexcom, Inc., Abbott, ViaCyte, Inc., Sanofi, Speaker's Bureau; Academy for Continued Healthcare Learning, Cardiometabolic Health Congress, Medscape, Integritas. S.F.Thung: None. A.Bartholomew: None. T.Summerfield: None. T.Bloks: None. Funding JDRF (2-SRA-2018-666-M-R); Colorado Clinical and Translational Sciences Institute; Children’s Diabetes Foundation; National Center for Research Resources (UL1RR02578)

177-LB: Association of Pregnancy and Childhood C-Peptide Levels—Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO-FUS)

Physiological insulin resistance partitions glucose for the growing fetus during the 2nd and 3rd trimester of pregnancy. The HAPO study has demonstrated that pregnancy hyperglycemia is associated with offspring adiposity, hyperglycemia, and glucose intolerance. Maternal insulin is a key regulator of the glucose physiology but does not cross the placenta. The goal of this study was to identify the association of pregnancy and offspring c-peptide levels, measured during oral glucose tolerance test (OGTT). Method: Using HAPO-FUS data from the NIH-NIDDK repository, multiple linear regression assessed the association of scaled pregnancy fasting and 1-hour c-peptide with cord c-peptide (at birth), and child c-peptide from OGTT at the follow-up visit (ages 10-14 years). Maternal covariates include pregnancy gestational age, BMI, glucose level and field center. Child covariates include age, sex, tanner stage, BMI z-score and glucose level. Multiple imputation was performed using missing at random assumption. Results: A total of 4,802 mother-child pairs were included. Pregnancy c-peptide was associated with cord c-peptide (fasting 0.02 [0.01-0.03], p &amp;lt;.001, 1-hour 0.01 [0.002-0.02], p =.006). Pregnancy fasting c-peptide was also associated with child OGTT c-peptide (fasting 0.03 [0.02-0.04], p &amp;lt;.001; 1-hour 0.11 [0.08-0.15], p &amp;lt;.001; 2-hour 0.01 [0.007-0.02], p &amp;lt;.001) and pregnancy 1-hour c-peptide (fasting 0.01 [0.007-0.02], p &amp;lt;.001; 1-hour 0.15 [0.12-0.17], p &amp;lt;.001; 2-hour 0.11 [0.09-0.14], p &amp;lt;.001). Similar associations were observed with child insulin levels. Pregnancy c-peptide levels were positively associated with HOMA-IR and negatively with child insulin sensitivity and Matsuda index while adjusting for child BMI z-score and pubertal stage. Conclusion: Pregnancy insulin levels are strongly associated with the child insulin response during OGTT. This suggests a role in the offspring pancreas developmental programming. Disclosure H. Zheng: None. A. Rajamoorthi: None. A. Skowronski: None. R. Salem: Other Relationship; Travere Inc. C. A. Leduc: None. V. V. Thaker: None. Funding National Institutes of Health (K23DK110539)

Reticulocyte haemoglobin equivalent (ret-he) as a marker of bioavailability of iron in pregnant female- a study of 75 cases in a tertiary care centre

Abstract Background: Anaemia is the most frequent derailment of physiology in the world throughout the life of a woman. Women in the gestational period have a higher risk of presenting with iron-deficiency anaemia. The anaemia may occur due to inadequate intake of dietary iron, greater foetal demand and haemodilution, a physiological anaemia common in pregnant women in which changes in the maternal organism, such as changes in blood volume and factors associated with haemostasis, decrease haemoglobin concentration. The aim of study is to utilize Ret-He as a marker of bioavailability of iron in pregnant female. Material and Methods: This was a retrospective and prospective study carried out for a duration of 1 years and included total of 75 cases referred to Pathology Department, M. P. Shah Govt. Medical College and Guru Gobind Singh Hospital, Jamnagar- Gujarat. Clinical history, RET-He and other important parameters as well as findings of all the concerned pregnant females were collected. Results:Age of pregnant females varied from 19 years to 42 years. Mean age being 25.2 years. The reference ranges of RET-Hewas between 32.1 and 38.8 pg with a median of 34.17 pg. Hb and/or ferritin level were low in 3 pregnant women in 1st trimester with anaemia, 7 in 2nd and in 16 patients in 3rd trimester. Conclusions: Early diagnosis of iron deficiency anaemia in pregnancy is essential to prevent damage to both maternal and foetal health. In this study, we showed that the RET-He presents an excellent supplementary tool for the diagnosis of iron deficiency in pregnant women. Keywords: Anaemia, Iron deficiency, Pregnancy diagnosis, Reticulocytes, RET-He.

Asupan omega-6 dan kejadian persalinan caesarean section di wilayah Puskesmas Bendosari

The prevalence of Cesarean Section (SC) childbirth in the Bendosari Health Center area is quite high, namely p in 2022 from January to March as much as 28.68% of the total 122 deliveries. One of the factors that cause cesarean section is PUFA intake, especially high omega-6 intake.  This study aims to determine the relationship between omega-6 intake and the incidence of cesarean section in postpartum mothers in the Bendosari Health Center area. This study was used an observational method with a cross sectional approach. The subjects of the study were 66 postpartum mothers and purposive sampling method was used because the number of postpartum mothers who have infants less than 3 months and had history of SC not by their will, not due to short birth spacing, not placenta previa and infection was limited. Sampling of postpartum mothers with infants 3 months of age is done with the aim of observing omega-6 consumption in the 2nd and 3rd trimesters. Data on omega-6 intake during the 2-3rd semester tri pregnancy period were obtained by direct interview method using the Semi Quantitative Food Frequency (SQ-FFQ) form while data method of delivery was obtained through secondary data from Bendosari Primary health care.  The association between omega-6 intake and the incidence of SC birth was analyzed using the Chi Square test. There was no relationship between omega-6 intake and the incidence of SC in the Bendosari Health Center area (P-value= 0.96). Keywords: omega-6 intake, cesarean section, pregnancy

Effects of intrauterine and post-natal exposure to air pollution on children’s pneumonia: Key roles in different particulate matters exposure during critical time windows

BackgroundDespite mounting evidence linked pneumonia with air pollution, it is unclear what main pollutant(s) exposure in which critical window(s) play a key role in pneumonia. ObjectiveTo examine effects of intrauterine and post-natal exposure to air pollution on children’s doctor-diagnosed pneumonia (DDP). MethodsA combination of cross-sectional and retrospective cohort study was conducted at Changsha, China during 2019–2020. Personal exposure to outdoor air pollutants at each child’s home address was estimated using inverse distance weighted (IDW) method based on data from 10 air quality monitoring stations. Associations between personal air pollution exposure and DDP were evaluated. ResultsChildren’s DDP was associated with intrauterine and post-natal exposure to PM2.5, PM2.5–10, and PM10, adjusted ORs (95% CI) of 1.17 (1.04–1.30), 1.09 (1.01–1.17), and 1.07 (1.00–1.14) for IQR increase in intrauterine exposure and 1.12 (1.02–1.22), 1.13 (1.06–1.21), and 1.28 (1.16–1.41) for post-natal exposure. Intrauterine PM2.5 exposure and post-natal PM10 exposure were associated with a higher risk of pneumonia. We identified the 2nd trimester, 3rd trimester, and first year as critical windows respectively for PM2.5, PM2.5–10, and PM10 exposure. Daytime exposure to traffic-related air pollution especially during early life increased DDP. ConclusionIntrauterine and post-natal exposure to particulate matters played a dominant role in children’s DDP.

#3512 GLOMERULOPATHIES DURING PREGNANCY: A TEN-YEAR SINGLE CENTER EXPERIENCE

Abstract Background and Aims Literature regarding pregnancy management and outcomes in women with glomerulopathies is still sparse. Specific guidelines for each glomerulopathy are still lacking which impairs a more homogeneous approach. The authors describe the multidisciplinary approach and the outcomes of pregnant women with primary and genetic glomerulopathies. Method Retrospective observational study in which the authors reviewed maternal, obstetric and perinatal outcomes in pregnant women with primary and genetic glomerulopathies surveilled at our nephro-obstetric clinic from 2011 to 2021. Results We evaluated 23 gestations in 20 patients (two pregnancies still ongoing). Mean age was 32.4±5.4 years (18-41), 17 women were caucasian, 3 black African, 10/23 nulliparous and 5/20 had chronic hypertension. Mean baseline SCr was 0.8±0.3mg/dl (0.5-1.8) and proteinuria was 1360±2199.6 mg/day (150-8615), with 13/6/2 patients being on CKD stage 1/2/3, before pregnancy, respectively (unknown in 2 patients). The most frequent CKD etiologies were IgA nephropathy (6/20), Focal Segmental Glomerulosclerosis (FSGS; 3/20) and Membranous nephropathy (2/20). Exposure to teratogenic therapy during the 1st trimester occurred in 5/23 gestations with a mean exposure of 7.0±3.6 weeks. De novo proteinuria and worsening proteinuria occurred in 3/23 and 16/23 patients, respectively, with full blown nephrotic syndrome in 4/23 patients. Renal function deteriorated in one patient (CKD G3). Kidney biopsy was performed in 1/20 and 3/20 patients during and post pregnancy, revealing IgA Nephropathy (2/20, 1 with superimposed FSGS), C3 glomerulonephritis (1/20) and FSGS (1/20). Genetic diagnosis was done during/post pregnancy in 3/1 patients. Aspirin and LMWH were started in 17/23 and 4/23 gestations, respectively. Immunosuppression consisted of cyclosporin or tacrolimus with or without low dose prednisolone in 6/23 patients with partial and complete remission in all patients. De novo and worsening hypertension occurred in 2/23 and 3/23 gestations, during the 3rd trimester. Preeclampsia developed in 1 patient at 32 weeks. Fetus malformation (trisomy 21) and severe nephrotic syndrome led to pregnancy termination during the 1st trimester in two pregnancies. Cesarean delivery was performed in 5 gestations mainly due to pelvic position. Mean gestation time was 38.9±2 weeks. There was one preterm delivery due to preeclampsia. Mean birth weight was 3076.6±630.7 mg (1500-3850), with 3 newborns having low birth weight (&amp;lt;2500g). Apgar scores at 1/5/10 minutes were 9/10/10, respectively. Neonatal intensive care was needed in 1 newborn. Conclusion In our series, glomerulopathies with proteinuria or nephrotic syndrome were not associated with poor renal and perinatal outcome, with only one patient developing PE and renal function deterioration, probably associated to with CKD stage 3. In patients with nephrotic syndrome, immunosuppression with calcineurin inhibitor and low dose prednisone was associated with complete or partial remission in all patients.

#3594 CHANGES IN ALBUMINURIA AND KIDNEY FUNCTION AFTER 8 WEEK HIGH-INTENSITY INTERVAL TRAINING PROGRAM IN 2ND AND 3RD TRIMESTER OF PHYSIOLOGICAL PREGNANCY

Abstract Background and Aims Physical exercise is the best prophylaxis of many disorders and should be continued during uncomplicated pregnancy. Several studies suggested that most pregnant women had no contraindications to perform intensive exercises. In recently published studies the beneficial effect of high-intensity interval training (HIIT) on both mental health and reduction of excessive weight gain during pregnancy has been demonstrated. The knowledge regarding kidney function after exercise in pregnancy is very scarce and only few studies concerning this topic were published. The aim of this study was to estimate changes in markers of kidney function in healthy pregnant exercising women. Changes after single intensive exercise and after 8 week training program were analyzed. Method The group of 36 women in 2nd and 3rd trimester of pregnancy were recruited to the study. At the beginning of the study all participants had normal kidney function (serum creatinine level below 0.6 mg/dl) and albuminuria (uACR below 30 mg/g) in rest. 19 women participated in 8-week HIIT program and 17 women in 8-week educational program (EDU group). Before and after 8 week training and education programs a progressive maximal exercise test on cyclometer was performed. Several biochemical measurements were performed. Results Women from both groups revealed mild changes concerning kidney function in rest, typical for physiological pregnancy (e.g. low sodium, creatinine and uric acid levels). After progressive maximal exercise test some unexpected findings were found: the fractional excretion of urea and uric acid increased (FeUrea from 41.25 to 50.05%; FeUA from 7.18 to 8.04%) and serum uric acid decreased significantly (sUA from 3.35 to 3.28mg/dL). Other changes after short exercise were typical: significant increase of uACR (from 5.12 to 9.43mg/g), serum creatinine (from 0.52 to 0.56mg/dL) and urea (from 16.45 to 21.65 mg/dL), among others. The 8-week HIIT training program did not change kidney function in rest. In both groups a significant increase of eCrCl and sUA were observed. The interesting observation was that uACR increased significantly only in EDU group. Conclusion Changes in kidney function after short intensive exercise in pregnancy were typical for healthy subjects, but there was no negative impact on markers of renal hypoperfusion. It was probably related to increased renal blood flow occurring in healthy pregnancy. The supervised 8-week HIIT training program had no negative impact on kidney function. The possible positive impact of this training on albuminuria was suggested.

Effect of prenatal exposure to organophosphates and pyrethroid pesticides on neonatal anthropometric measures and gestational age

Several studies have examined the association between prenatal exposure to organophosphate and pyrethroid pesticides and their impact on foetal growth and newborn anthropometry; however, the available evidence is limited and inconclusive. This study examined whether prenatal organophosphate and pyrethroid pesticide exposure was associated with anthropometric measures at birth (weight, length, head circumference), ponderal index, gestational age, and prematurity in 537 mother-child pairs. These were randomly selected from the 800 pairs participating in the prospective birth cohort GENEIDA (Genetics, early life environmental exposures and infant development in Andalusia). Six non-specific organophosphate metabolites (dialkylphosphates, DAPs), one metabolite relatively specific to chlorpyrifos (3,5,6-trichloro-2-pyridinol, TCPy) and a common metabolite to several pyrethroids (3-phenoxybenzoic acid, 3-PBA) were measured in maternal urine from the 1st and 3rd pregnancy trimesters. Information on anthropometric measures at birth, gestational age and prematurity was retrieved from medical records. The sum on a molar basis of DAPs with methyl (ƩDMs) and ethyl (ƩDEs) moieties and the sum of the 6 DAPs metabolites (ƩDAPs) was calculated for both trimesters of pregnancy. High urinary levels of dimethyl phosphate (DMP) during the 3rd trimester were associated with a decrease in birth weight (β = −0.24; 95% CI: 0.41; −0.06) and birth length (β = −0.20; 95% CI: 0.41; 0.02). Likewise, ΣDMs during 3rd trimester were near-significantly associated with decreased birth weight (β = −0.18; 95% CI: 0.37; 0.01). In turn, increased urinary TCPy during 1st trimester was associated with a decreased head circumference (β = −0.31; 95% CI: 0.57; −0.06). Finally, an increase in 3-PBA in the 1st trimester was associated with a decreased gestational age (β = −0.36 95% CI: 0.65–0.08), whereas increased 3-PBA at 1st and 3rd trimester was associated with prematurity. These results indicate that prenatal exposure to organophosphate and pyrethroid insecticides could affect normal foetal growth, shorten gestational age and alter anthropometric measures at birth.

"The Name of This is Fourth Trimester. A Lot of People Don't Know About it": A Qualitative Analysis to Inform the Development of a Web-Based Tool.

The purpose of this qualitative study is to understand the pregnant and postpartum experiences of Black women in the United States to inform the development of a web-based mobile tool. Participants were recruited through Facebook Groups. There were a total of 19 women that participated in one of five focus group discussions. Participants ranged from being in their 3rd trimester of pregnancy through 6 months postpartum. Thematic content analysis was performed to identify emerging themes. Four themes emerged from the focus group discussions: beliefs about postpartum motherhood, experiences during pregnancy, experiences of the postpartum period, and tool recommendations. Key results from these themes demonstrated the difficulties that women faced in having their concerns resolved by healthcare professionals, receiving adequate educational and social support during the COVID-19 pandemic, and having adequate information to help breastfeed and cope with changes they experienced throughout the postpartum period. The results highlight the difficulties that Black women experienced throughout pregnancy and the postpartum period. The main findings show that women lacked support in receiving information about the postpartum period, had their concerns dismissed by healthcare professionals, and received inadequate support. These findings can inform the practice of healthcare professionals and inform the development of other non-clinical, digital resources to fill in these gaps. Future research in this area is planned to further develop and pilot the tool among a broader population of women.

Maternal exposure to benzophenone derivatives and their impacts on offspring's birth outcomes in a Middle Eastern population

Widespread use of benzophenones (BPs), a group of environmental phenolic compounds, is suspected of interfering with human health. The association of prenatal exposure to benzophenone derivatives with birth outcomes including birth weight and length, head, arm and thoracic circumference, abnormalities, corpulence index and anterior fontanelle diameter (AFD) was investigated. Mother-infant pairs of 166 within PERSIAN cohort population in Isfahan, Iran, in the 1st and 3rd trimesters of pregnancy were assessed. Four common benzophenone metabolites including 2,4-dihydroxy benzophenone (BP-1), 2-hydroxy-4-methoxy benzophenone (BP-3), 4-hydroxy benzophenone (4-OH-BP) and 2,2′-dihydroxy-4-methoxy benzophenone (BP-8) were measured in maternal urine samples. The median concentration of 4-OH-BP, BP-3, BP-1 and BP-8 were 3.15, 16.98, 9.95 and 1.04 µg/g Cr, respectively. In the 1st trimester, 4-OH-BP showed a significant correlation with AFD in total infants, decreasing 0.034 cm AFD per a log unit increase of 4-OH-BP. Within the male neonates, 4-OH-BP in the 1st and BP-8 in the 3rd trimester were significantly associated with head circumference and AFD increase, respectively. Among female neonates in the 3rd trimester, increasing 4-OH-BP and BP-3 concentration was correlated with a decrease in birth weight and AFD, respectively. This study demonstrated that all the target BP derivatives can influence normal fetal growth at any age of the pregnancy, nevertheless, to support these findings further studies are needed in a large and different group population.