Healthy Nulliparous Women Research Articles

Inherited Thrombophilia Polymorphisms and Pregnancy Outcomes in Nulliparous Women

Said, J.M.; Higgins, J.R.; Moses, E.K.; Walker, S.P.; Borg, A.J.; Monagle, P.T.; Brennecke, S.P. Author Information

Latex Sensitization

Previous studies have reported a greater frequency of sensitization to latex in the female population and a higher incidence of anaphylactic reactions to latex during cesarean section. In this study, the authors investigated the prevalence of latex sensitization in obstetric patients compared with nonpregnant subjects. Two hundred ninety-four healthy pregnant women who were at term with a singleton fetus and scheduled for caesarean section (group A) were compared with 294 healthy nulliparous women with childbirth potential undergoing gynecologic surgery (group B). Before surgery, patients completed a questionnaire, and venous blood samples were collected to measure specific immunoglobulin E serum concentrations with a fluorescent enzyme immunoassay test. Skin-prick tests were performed if adverse reactions occurred during surgery. Latex allergy was diagnosed on the basis of immunoglobulin E results and/or positive skin-prick tests. The prevalence of latex sensitization was higher in group A than in group B (15/294, 5.1% vs. 5/294, 1.7%; P < 0.05). A significant difference in specific immunoglobulin E serum concentration was noted between pregnant and nonpregnant patients who had a positive fluorescent enzyme immunoassay test (median serum concentration: 1.93 kilounits/l; interquartile range = 2.28 vs. 0.78 kilounits/l; interquartile range = 1.07; P less than 0.05). Two patients in group A experienced an anaphylactic reaction to latex. Statistical analysis disclosed no association between latex sensitization and accepted risk factor for latex allergy. The authors report a higher prevalence of latex sensitization in the obstetric population than in nonpregnant subjects undergoing gynecologic surgery.

Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort

Objectives To develop a predictive model for pre-eclampsia based on clinical risk factors for nulliparous women and to identify a subgroup at increased risk, in whom specialist referral might be...

Complement component C4A and apolipoprotein A-I in plasmas as biomarkers of the severe, early-onset preeclampsia

Preeclampsia is a common pregnancy complication that is associated with maternal perinatal morbidity and mortality. Because of its early onset (before 34 weeks) and the potential for serious outcomes, severe, early-onset preeclampsia (sePE) should be regarded as a different form of preeclampsia. It is an important cause of preterm birth and fetal growth restriction and adverse maternal and neonatal outcomes. As there is no diagnostic test yet available for this disease, we used a proteomic approach to identify novel plasma biomarkers for developing severe, early-onset preeclampsia. We conducted case-control studies comparing nulliparous women with severe preeclampsia requiring delivery prior to 34 weeks of gestation with healthy nulliparous women matched by gestational age at sampling. Plasma was depleted of albumin and IgG and analyzed by two-dimensional gel electrophoresis (2DE). Seven specific plasma proteins for early-onset preeclampsia were detected by mass spectrometry had statistically significant expression differences when compared to controls. The expression of complement component C4A and apolipoprotein A-I were validated by immunoblotting. The complement component C4A in the plasmas of sePE women is lower than the severe, late-onset PE (slPE) women [mean ± SD; 3.05 ± 0.14 times reference level (normal/sePE) in sePE women vs. 2.73 ± 0.10 times reference level (normal/slPE) in slPE women, P < 0.05]. Apolipoprotein A-I is higher in sePE women than slPE women [mean ± SD; 1.58 ± 0.14 times reference level (sePE/normal) in sePE women vs. 1.04 ± 0.16 times reference level (slPE/normal) in slPE women, P < 0.05]. Furthermore, C4A can accurately distinguish severe PE (sePE and slPE) from mild PE (mePE and mlPE) and was proved by the results of ELISA. Further studies have been done to determine the relation between PE and hypoxia. JAR cells were cultured under hypoxia for 72 h. Total cellular proteins were gathered and lysed. Lower C4A and higher apolipoprotein A-I had been observed in JAR of hypoxia conditions than normoxia conditions through western blotting. The result proved that PE is correlated with hypoxia. In summary, C4A and apolipoprotein A-I are able to function as markers to distinguish ePE women from lPE women, and severe PE from mild PE, or perhaps even as disease predictors that might become relevant for diagnostics.

Risk factors for small‐for‐gestational‐age infants by customised birthweight centiles: data from an international prospective cohort study

Please cite this paper as: McCowan L, Roberts C, Dekker G, Taylor R, Chan E, Kenny L, Baker P, Moss‐Morris R, Chappell L, North R on behalf of the SCOPE consortium. Risk factors for small‐for‐gestational‐age infants by customised birthweight centiles: data from an international prospective cohort study. BJOG 2010;117:1599–1607.Objective To identify clinical and ultrasound variables associated with the birth of small‐for‐gestational‐age (SGA) infants by customised centiles, subclassified according to whether their mothers were normotensive or developed hypertensive complications.Design Prospective, multicentre cohort study.Setting Participating centres of the Screening for Pregnancy Endpoints (SCOPE) study in Auckland, New Zealand, Adelaide, Australia, Manchester and London, UK, and Cork, Ireland.Population The 3513 nulliparous participants of the SCOPE study.Methods Women were interviewed at 15 ± 1 weeks, and had ultrasound growth measurements and umbilical and uterine Doppler studies at 20 ± 1 weeks. Variables associated with SGA infants were identifed using logistic regression.Main outcome measures Small for gestational age (i.e. a birthweight of less than the tenth customised centile), normotensive‐SGA and hypertensive‐SGA. Comparison groups for statistical analyses were non‐SGA, normotensive non‐SGA and hypertensive non‐SGA.Results Among 376 (10.7%) SGA infants, 281 (74.7%) were normotensive‐SGA and 95 (25.3%) were hypertensive‐SGA. Independent risk factors for normotensive‐SGA were low maternal birthweight, low fruit intake pre‐pregnancy, cigarette smoking, increasing maternal age, daily vigorous exercise, being a tertiary student, head and abdominal circumference of less than the tenth centile and increasing uterine artery Doppler indices at the 20‐week scan. Protective factors were: high green leafy vegetable intake pre‐pregnancy, and rhesus‐negative blood group. Risk factors for hypertensive‐SGA were conception by in vitro fertilisation, previous early pregnancy loss and femur length of less than tenth centile at the 20‐week scan.Conclusions Risk factors for infants who are SGA by customised centiles have been identified in a cohort of healthy nulliparous women. A number of these factors are modifiable; however, further studies are needed to replicate these findings.

Exercise Training in Pregnancy Reduces Offspring Size Without Changes in Maternal Insulin Sensitivity

Elevated neonatal birth size is associated with risk for the development of overweight and obesity in childhood. A large body of evidence has demonstrated the importance of the in utero environment in determining growth in postnatal life. Numerous studies have suggested that reduction in maternal insulin sensitivity in the maternal environment contributes significantly to fetal growth. There is an inverse relationship between birth size and both very low and very high maternal insulin sensitivity. Accordingly, marked reduction in maternal insulin sensitivity in late stages of pregnancy has been linked to the preservation of fetal nutrient availability for growth, and thereby increased offspring birth size. It has been suggested that regular exercise may reduce offspring size by regulating the nutrient supply to the fetus through increases in maternal insulin sensitivity. Few data exist on the metabolic consequences of maternal exercising during pregnancy for mother and offspring. This community-based, randomized, controlled trial investigated the effects of aerobic exercise training during the second half of pregnancy on maternal insulin sensitivity and neonatal outcomes. The participants were 84 healthy nulliparous singleton women at a mean age of 30 years, mean body mass index (BMI) of 25.5, and at less than 20 weeks' gestation. Of the 84 randomized subjects, 47 in the exercise group and 37 in the control completed both baseline and late gestation assessments. Aerobic exercise intervention was a home-based stationary cycling program performed by study subjects from 20 weeks of gestation till the delivery. The primary study outcome measures were offspring birth weight and maternal insulin sensitivity. Measures of neonatal auxology determined at birth included birth weight and BMI and were reported as standard deviation scores (SDS). Venous cord blood samples were collected at delivery to assess fetal concentrations of growth-related peptides (IGF-1 and IGF-2). The study was performed according to intention-to-treat analysis. After adjustment for gender and gestational age at delivery, exercisers had lower birth weight (SDS, control: 0.23 ± 0.8 vs. exercise: -0.19 ± 0.9; P = 0.03) and BMI at birth (SDS, control: 0.40 ± 0.9 vs. exercise: -0.01 ± 0.09; P = 0.04). The reduction in maternal insulin sensitivity occurring in late gestation was not correlated with either exercise or offspring size. Cord serum concentrations of serum IGF-1 (P = 0.03) and IGF-2 (P = 0.04) were lower in offspring of exercisers compared with control offspring. These data suggest that maternal exercise has an effect on decreased endocrine stimulation of fetal growth. The reduction in birth weight after exercise training is not associated with changes in maternal insulin sensitivity.

Addition of low-dose morphine to intrathecal bupivacaine/sufentanil labour analgesia: A randomised controlled study

Background Single-shot spinal analgesia with bupivacaine and a short-acting opioid for labour pain is popular due to its simplicity, rapid onset, and profound analgesia without significant motor block. Its limitation is the short duration of action. Supplementation with intrathecal morphine has been shown to prolong analgesia. We compared the addition of placebo or morphine 50 or 100 μg to intrathecal bupivacaine and sufentanil to evaluate the impact on duration of labour analgesia. Method Following ethics committee approval and verbal and written patient consent, 90 healthy nulliparous women were included in the study. As part of a combined spinal-epidural technique, women were randomised to receive intrathecal bupivacaine 1.25 mg and sufentanil 5 μg with morphine 50 μg, 100 μg or saline placebo in a double-blind fashion. Onset of analgesia was measured as the time from intrathecal injection to a visual analogue scale pain score ⩽4 (scale 0–10) and the duration of analgesia as the time from intrathecal injection to the return of pain >4. Results No significant differences between the groups were seen in onset or duration of analgesia, side effects or obstetric and neonatal outcome. Conclusion The addition of 50 or 100 μg morphine to 1.25 mg bupivacaine and 5 μg sufentanil during established labour did not significantly increase the duration of analgesia.

Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing—a dynamic MRI investigation in healthy females

the aim of this pilot study was to demonstrate physiological movements of the muscular walls surrounding the abdominal cavity during breathing and coughing in healthy nulliparous women by means of real-time dynamic magnetic resonance imaging (MRI). eight volunteers underwent MRI measurements in a 1.5-T whole body MR-scanner. Coronal and sagittal slices were acquired simultaneously to assess respiratory-related cranio-caudal movement of diaphragm and pelvic floor (PF) and concomitant changes in horizontal abdominal diameter. respective mean amplitudes of cranio-caudal movement of the right and left diaphragmatic cupolae were 15 ± 6 and 9 ± 7 mm during quiet breathing; 32 ± 15 and 28 ± 16 mm during forceful breathing; and 32 ± 13 and 28 ± 7 mm during coughing. Both diaphragm and PF moved caudally during inspiration and cranially during expiration. Abdominal diameter decreased in all eight women consistently during the expiration phase of breathing, and in five women during coughing. in healthy women, real-time dynamic MRI demonstrates parallel cranio-caudal movement of the diaphragm and the PF during breathing and coughing and synchronous changes in abdominal wall diameter.

Identification of latent phase factors associated with active labor duration in low‐risk nulliparous women with spontaneous contractions

The aim of this prospective study was to identify latent phase predictors of active labor duration. Prospective clinical study. Two delivery units in Sweden. Healthy nulliparous women with a normal pregnancy, spontaneous onset of active labor at term, and a cervical dilatation of 4 cm or more on admission to the delivery ward (n = 2,072). The women were asked to answer questions concerning their food and fluid intake, amount of rest and sleep during the preceding 24 hours and to assess their labor pain, sense of security and expectations of the childbirth on a visual analog scale (VAS). Duration and intervals of contractions, cervical dilatation, and position of the fetal head were noted by the midwife. A multiple regression analysis was performed with active labor duration as the outcome variable. Predictive factors of active labor duration. Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within 2 hours of admission, high maternal age and malposition of the fetal head were controlled for. New findings are that latent phase duration as well as food intake and the amount of rest and sleep during the preceding 24 hours are independent predictors of labor duration.

Examen dynamique du muscle élévateur de l’anus de la femme par modélisation vectorielle 3D IRM : étude préliminaire

The levator ani muscle has a major role in the female pelvic floor, and is involved in the pathophysiology of pelvic prolapse and stress urinary incontinence. We conducted an anatomical and morphological study of this muscle using dynamic 3D vectorial reconstruction MRI, in order to analyze the contraction of two major components of the levator ani: the iliococcygeus and pubococcygeus. Three volunteer healthy continent nulliparous women aged from 19 to 22 underwent dynamic pelvic MRI. Coronal T2-weighted pelvic images were obtained in the supine position, at rest, holding back, and during Valsalva stress effort. 3D vectorial models were reconstructed by manual segmentation of the source images, and were set up on bony anatomic marks. Iliococcygeus and pubococcygeus volumes were measured in the three positions. Volumetrics, displacement and dynamic morphing changes were analyzed with 3D vectorial animation software. The urogenital hiatus extended more holding back (mean +4.31 mm) than on effort (mean +2.78 mm). The iliococcygeus lowered (mean -3.95 mm) and deviated outward (mean +3.01 mm). The basic tone of the iliococcygeus muscle gives it a dome shape, and its reflex contraction against abdominal strain ensures anal and urinary continence The levator ani is more than a pelvic diaphragm: it is a truly dynamic pelvic floor. Its points of support on the stiff osseous frame allow it to retain the pelvic organs. The levator ani muscle seems to prevent anal prolapse during stress strain.

Does Low Molecular Weight Heparin Shorten Term Labor?

Clinical experience has fostered the belief among some clinicians that women who receive low molecular weight heparins (LMWHs) are less likely to have protracted labor and therefore, less likely to require operative delivery. Previous studies have identified changes in the uterine and cervical extracellular matrix of heparan sulfate proteoglycans in normal and protracted labor. These changes and clinical observations suggest that LMWHs may influence the parturition process and shorten delivery time. This retrospective study investigated the effects of LMWHs on parturition time in pregnant women with a history of thrombotic disorders. The study subjects were 99 nulliparous pregnant women who had been treated with an LMWH (dalteparin) because of a history of previous venous thromboembolism, thrombophilia, or an acute venous thromboembolism during the current pregnancy. The women had been treated for 1 to 6 months before delivery. The control group was comprised of 198 untreated healthy nulliparous women with spontaneous onset of labor matched according to age and parity. The study and control groups were compared with respect to labor time, proportion of operative deliveries, and neonatal outcomes. Among women who had a spontaneous vaginal delivery, labor time was significantly shorter in those treated with dalteparin than in the untreated controls (6 vs. 9 hours, P < 0.0001). The number of operative deliveries was the same in the dalteparin and control groups, but the dalteparin-treated women required fewer operative interventions due to protracted labor (P = 0.0014). There was no difference in neonatal outcome between the groups. These findings suggest that LMWH therapy is associated with shorter labor time and a decreased number of operative interventions for protracted labor.

Sleep Disturbances in Pregnancy

A number of studies have reported associations between sleep disorders and adverse outcomes in both elderly and younger populations, but because few included pregnant women it is unclear whether sleep abnormalities during pregnancy are associated with adverse health consequences. Previous reports on sleep and pregnancy have focused only on specific sleep disturbances such as snoring, and most have studied a very heterogeneous population and included women with preexisting medical conditions. Few investigators have evaluated changes in sleep disturbances across pregnancy, or in women without chronic medical conditions that could independently affect sleep. This prospective observational study evaluated the prevalence of sleep disturbances among a population of healthy nulliparous women and quantified changes in sleep during pregnancy. Between February 2007 and June 2008, a total of 189 study subjects completed a sleep survey questionnaire at baseline early in pregnancy at 6 to 20 weeks and again in the third trimester at 28 to 40 weeks. The questionnaire was self-administered and contained items from several validated sleep surveys including the Berlin Questionnaire for Sleep-Disordered Breathing, the Epworth Sleepiness Scale, the National Institutes of Health/International Restless Legs Syndrome Question Set, the Women's Health Initiative Insomnia Rating Scale, and the Pittsburgh Sleep Quality Index. Overall changes in sleep characteristics between the baseline and third-trimester surveys were estimated through the use of the paired t-test for continuous variables and the McNemar test for categorical data. The mean gestational age of the participants at the first and second surveys was 13.8 ± 3.8 and 30.0 ± 2.2 weeks. The data showed that mean sleep duration was shortened from 7.4 ± 1.2 hours in the initial survey to 7.1 ± 1.3 in the third trimester survey (P < 0.001). Compared to baseline assessment, the percentage of patients with frequent snoring (at least 3 nights per week) was significantly increased in the third trimester (11.1% vs. 16.4%, P = 0.03). The proportion of women with test results positive for restless leg syndrome increased from 17.5% to 31.2% (P = 0.001). In addition, the overall poor sleep quality defined as a Pittsburgh Sleep Quality Index score above 5 was more common in the third trimester (39.0% vs. 53.5% (P = 0.001). These findings show that sleep disturbances are common in healthy nulliparous pregnant women, especially in the third trimester.

Exercise Training in Pregnancy Reduces Offspring Size without Changes in Maternal Insulin Sensitivity

Epidemiological studies have identified the importance of the in utero environment in providing a healthy start to life. Previous studies have suggested that the maternal environment, in particular a reduction in maternal insulin sensitivity, contributes significantly to fetal growth. Regular aerobic exercise, through an effect on maternal insulin sensitivity, may influence offspring size by regulating nutrient supply to the fetus. The aim of the study was to determine the effects of aerobic exercise training in the second half of pregnancy on maternal insulin sensitivity and neonatal outcomes. We conducted a community-based, randomized, controlled trial of exercise in pregnancy. Eighty-four healthy nulliparous women (mean +/- sd, age, 30 +/- 4 yr; body mass index, 25.5 +/- 4 kg/m(2)) participated in the study. Subjects participated in a home-based stationary cycling program from 20 wk gestation to delivery. Maternal insulin sensitivity, neonatal auxology, body composition, and growth-related peptides in cord blood were measured. Offspring of exercisers had lower birth weight (sd score, control, 0.23 +/- 0.8; exercise, -0.19 +/- 0.9; P = 0.03) and body mass index at birth (sd score, control, 0.40 +/- 0.9; exercise, -0.01 +/- 0.09; P = 0.04). The reduction in maternal insulin sensitivity in late gestation was not affected by exercise (P = 0.45) and was unrelated to offspring size. Exercise offspring had lower cord serum IGF-I (P = 0.03) and IGF-II (P = 0.04). Regular exercise was associated with lower birth weights and reduced cord concentrations of growth-related peptides, suggesting an influence of exercise on endocrine regulation of fetal growth. These effects on offspring growth were not associated with an exercise training effect on maternal insulin sensitivity.

Patterns of Change in Uterine Artery Doppler Studies Between 20 and 24 Weeks of Gestation and Pregnancy Outcomes

OBJECTIVES: To describe changes in mean uterine artery resistance index and bilateral notches between 20 and 24 weeks of gestation in healthy nulliparous women and to relate these changes to pregnancy outcome. METHODS: A total of 2,189 nulliparous participants in the Screening for Pregnancy Endpoints study had pregnancy outcomes compared between four uterine artery Doppler groups: normal at 20 and 24 weeks of gestation (group 1), normal at 20 weeks and abnormal at 24 weeks (group 2), abnormal at 20 weeks and normal at 24 weeks (group 3), and abnormal at both 20 and 24 weeks (group 4). Abnormal uterine Doppler was defined as 1) mean resistance index greater than the 90th centile; 2) bilateral notches; and 3) a combination of 1, 2, or both. The main outcomes were preeclampsia and small for gestational age (SGA) neonates (less than the 10th customized centile). RESULTS: Preeclampsia developed in 116 (5.3%) women, and 223 (10.2%) delivered SGA neonates. With abnormal Doppler defined as mean resistance index greater than the 90th centile, the rate of SGA increased across Doppler groups: group 1, 156 (8.4%); group 2, 13 (11%); group 3, 25 (19.5%); and group 4, 29 (35.4%) (P<.001). The rate of SGA was higher in group 3 compared with group 1. Preeclampsia differed among groups 1 (85 [4.6%]), 2 (9 [7.6%], 3 (7 [5.5%]), and 4 (15 [18.3%]) (P<.001). CONCLUSION: Pregnancy outcomes in women with abnormal uterine artery Doppler results at either 20 or 24 weeks were intermediate between those with normal or abnormal results at both time points. If overall test performance could be enhanced by the addition of clinical data, biomarkers, or both, we would recommend that 20 weeks is the most appropriate gestation in the second trimester to perform uterine artery Doppler studies.

Sleep Disturbances in Pregnancy

To estimate the prevalence and patterns of sleep disturbances during pregnancy among healthy nulliparous women. This was a prospective, cohort study of healthy nulliparous women, recruited between 6 and 20 weeks of gestation, who completed a baseline sleep survey at enrollment with follow-up in the third trimester. The survey was composed of the following validated sleep questionnaires: Berlin Questionnaire for Sleep Disordered Breathing, Epworth Sleepiness Scale, National Institutes of Health/International Restless Legs Syndrome Question Set, Women's Health Initiative Insomnia Rating Scale, and the Pittsburgh Sleep Quality Index. Differences in sleep characteristics between the baseline and third trimester were compared using the paired t test or McNemar test for continuous or categorical data, respectively. One hundred eighty-nine women completed both baseline and follow-up sleep surveys. The mean gestational age was 13.8 (+/-3.8) and 30.0 (+/-2.2) weeks at the first and second surveys, respectively. Compared with the baseline assessment, mean sleep duration was significantly shorter (7.4 [+/-1.2] hours compared with 7.0 [+/-1.3] hours, P<.001), and the proportion of patients who reported frequent snoring (at least three nights per week) was significantly greater (11% compared with 16.4%, P=.03) in the third trimester. The percentage of patients who met diagnostic criteria for restless leg syndrome increased from 17.5% at recruitment to 31.2% in the third trimester (P=.001). Overall poor sleep quality, as defined by a Pittsburgh Sleep Quality Index score greater than 5, became significantly more common as pregnancy progressed (39.0% compared with 53.5%, P=.001). Sleep disturbances are prevalent among healthy nulliparous women and increase significantly during pregnancy. II.

Inherited Thrombophilia Polymorphisms and Pregnancy Outcomes in Nulliparous Women

To estimate the association between five commonly inherited thrombophilia polymorphisms and adverse pregnancy outcomes in women who had no prior history of adverse pregnancy outcomes or personal or family history of venous thromboembolism. Healthy nulliparous women (n=2,034) were recruited to this prospective cohort study before 22 weeks of gestation. Genotyping for factor V Leiden, prothrombin gene mutation, methylenetetrahydrofolate reductase enzyme (MTHFR) C677T, MTHFR A1298C, and thrombomodulin polymorphism was performed. Clinicians caring for women were blinded to the results of thrombophilia tests. The primary composite outcome was the development of severe preeclampsia, fetal growth restriction, placental abruption, stillbirth, or neonatal death. Complete molecular results and pregnancy outcome data were available in 1,707 women. These complications were experienced by 136 women (8.0%). Multivariable logistic regression demonstrated two statistically significant findings. Women who carried the prothrombin gene mutation had an odds ratio of 3.58 (95% confidence interval [CI] 1.20-10.61, P=.02) for the development of the composite primary outcome. Homozygous carriers of the MTHFR 1298 polymorphism had an odds ratio of 0.26 (95% CI 0.08-0.86, P=.03). None of the other polymorphisms studied showed a significant association with the development of the primary outcome in this cohort of women. Prothrombin gene mutation confers an increased risk for the development of adverse pregnancy outcomes in otherwise asymptomatic, nulliparous women, whereas homozygosity for MTHFR 1298 may protect against these complications. The majority of asymptomatic women who carry an inherited thrombophilia polymorphism have a successful pregnancy outcome. II.

161. PREDICTING GESTATIONAL HYPERTENSION AND PREECLAMPSIA FROM MATERNAL ANGIOTENSIN II AND ANGIOTENSIN 1–7 LEVELS AT 15 WEEKS GESTATION

Angiotensin II (AngII) is the main effector peptide of the renin angiotensin system (RAS). The RAS is also involved in the aetiology of hypertension. Angiotensin 1–7 (Ang1–7) acting on the Mas receptor may counteract AngII effects. RAS activity is increased in early gestation. We wanted to determine if maternal plasma AngII and Ang1–7 levels in early gestation predict the onset of hypertension in late gestation. Circulating AngII and Ang1–7 have been measured by RIA (D Casley, Prosearch Pty. Ltd.) in EDTA treated plasma from healthy nulliparous pregnant women at 15 weeks gestation from the Adelaide SCOPE cohort for preeclampsia (PE) (n = 50) and gestational hypertension (GHT) (n = 50), with 131 controls. Log transformation and linear regression showed an inverse, weak (R2 = 0.068), statistically significant relationship (P = 0.003) between AngII and Ang1–7. The predictive capability of these peptides for pregnancy outcome was determined by logistic regression and area under the curve after ROC analysis (AROC). The summaries of these analyses are shown in Table 1. AngII did not increase the predictive strength of either model and was omitted. These models show for the first time that circulating Ang1–7 levels are highly statistically significant predictors of hypertensive diseases of pregnancy as early as 15 weeks gestation, well before diagnosis of disease.

306. PREDICTING GESTATIONAL DIABETES FROM MATERNAL ANGIOTENSIN II AND ANGIOTENSIN 1–7 LEVELS AT 15 WEEKS GESTATION

Gestational diabetes (GD), a pregnancy complication defined by glucose intolerance with onset during pregnancy, is a condition affecting 5.5%–8.8% of Australian pregnancies1. Untreated GD increases perinatal mortality and babies from GD pregnancies have an increased risk of diabetes and obesity, whilst mothers have an increased risk of type II diabetes later in life1. Circulating levels of angiotensin 1–7 (Ang1–7), a peptide of the renin angiotensin system, have been reported to be reduced in third trimester pregnancies with GD2. The effects of Ang1–7 generally oppose those of angiotensin II (AngII) and it is possible that in early gestation pro-angiogenic functions of AngII are counterbalanced by Ang1–7, causing placental insufficiency and pregnancy complications. We wanted to determine the predictive capability of AngII and Ang1–7, in early gestation, for GD. Healthy nulliparous pregnant women from the Adelaide SCOPE cohort with GD (n = 36) or serving as controls (n = 131) had both peptides measured at 15 weeks using an RIA (D. Casley, Prosearch Pty. Ltd.) on EDTA treated plasma. A predictive model was constructed using logistic regression and area under the curve after ROC analysis (AROC, Table 1). AngII did not change the model and was omitted. This model shows that for every one unit increase of Log (Ang1–7 pg/mL) peptide levels the odds of acquiring GD increase five times, suggesting that Ang1–7 levels in early gestation may be a better disease marker than those seen at late pregnancy. (1) Hoffman L, Nolan C, Wilson JD, et al., 1998. Gestational diabetes mellitus – management guidelines. The Australasian Diabetes in Pregnancy Society. Med. J. Aust. 169, 93–97.(2) Nogueira AI, Santos RAS, Simoes e Silva AC, et al., 2007. The pregnancy-induced increase of plasma angiotensin-(1–7) is blunted in gestational diabetes. Regul. Pep., 141, 55–60.

Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women

The aim of this cross-sectional study was to determine correlations between pelvic floor muscle (PFM) function and expiratory function in healthy young nulliparous women. In 40 volunteers, PFM function was assessed by vaginal palpation. Forced expiration patterns were evaluated visually and by palpation of the suprapubic insertion region of the anterolateral abdominal muscles. Forced vital capacity (FVC) and forced expiratory flows (FEF) were determined by spirometry. Incremental positive correlation was found between voluntary PFM contraction strength and forced expiratory flow at 25%, 50% and 75% (FEF(25%), FEF(50%), FEF(75%)) of the FVC, respectively. Positive correlation was also found between PFM contraction strength and forced expired volume in 1 s (FEV(1)). No correlation was found between PFM contraction strength and FVC or peak expiratory flow (PEF). Despite some limitations of this study, the observed correlation between PFM contraction strength and forced expiratory flows may serve as theoretical background for a potential role of coordinated abdominal and PFM training in diseases with expiratory flow limitations.

Caesarean Section on Maternal Request: Risks and Benefits in Healthy Nulliparous Women and Their Infants

ObjectiveTo determine the risks and benefits of an elective Caesarean section (CS) at term in healthy nulliparous women. MethodsWe conducted a population-based cohort study of deliveries between 1994 and 2002. Using bivariate and multivariable techniques, we compared maternal and neonatal outcomes in healthy nulliparous women who had undergone elective pre-labour CS (using breech presentation as a surrogate) with those in women who had undergone spontaneous labour with anticipated vaginal delivery (SL) at full term. ResultsThere were 1046 deliveries in the pre-labour CS group and 38 021 in the SL group. Life-threatening maternal morbidity was similar in each group. Life-threatening neonatal morbidity was decreased in the CS group (RR 0.34; 99% CI 0.12 to 0.97). Subgroup analysis of the SL group by mode of delivery demonstrated the increased neonatal risk was associated with operative vaginal delivery and intrapartum CS but not spontaneous vaginal delivery. ConclusionAn elective pre-labour Caesarean section in a nulliparous woman at full term decreased the risk of life-threatening neonatal morbidity compared with spontaneous labour with anticipated vaginal delivery. However, the 63% of women with spontaneous labour who achieved a spontaneous vaginal delivery would not have benefited from delivery by Caesarean section. Further research is needed to better identify women with an increased likelihood of an operative vaginal or intrapartum Caesarean section, as this may assist maternity caregivers in decision-making about childbirth. Further research is also needed to determine if these findings can be confirmed in a prospective study.