Risk Of Pregnancy Complications Research Articles

Trends in maternal characteristics, and maternal and neonatal outcomes of women with gestational diabetes: A study from Jordan

BackgroundGestational diabetes mellitus (GDM) is a major health issue that poses its risk on pregnancy. It is prevalence has been globally increasing. AimThis study aimed to examine trends in demographic and socioeconomic characteristics, maternal BMI, behavioral factors, obstetric interventions, pregnancy complications, and maternal pre-existing medical conditions and maternal and neonatal outcomes in women with GDM in Jordan. We also aimed to equate the occurrence of emergency cesarean delivery with GDM. MethodsThe study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared among women who did not develop gestational diabetes mellitus and those who developed gestational diabetes mellitus. ResultsThe overall incidence rate of gestational diabetes mellitus (GDM) was 1.2%. Women with gestational diabetes had a higher weight, and BMI, more likely to be overweight, obese, or morbidly obese and less likelihood to be underweight. A significant association was detected between previous spontaneous abortions/miscarriages, previous preterm, previous stillbirths, previous children born with birth weight less than 2500 g, and previous children born alive and died before 28 days, and the incidence of GDM. Women with GDM were at high risk for complications in pregnancy such as hypertension, preeclampsia, premature delivery and labor induction. The offspring of GDM patients were at high risk of complications such as macrosomia, stillbirth, neonatal hypoglycemia, and neonatal jaundice and admittance to the NICU. ConclusionsThe incidence of GDM was linked to several clinical factors. Women with GDM are at high risk for complications of pregnancy and at higher risk of neonatal complications.

False-Positive Maternal Serum Screens in the Second Trimester as Markers of Placentally Mediated Complications Later in Pregnancy: A Systematic Review and Meta-Analysis.

Background Multiple-marker, maternal serum screening (MSS) has been the cornerstone of prenatal diagnosis since the 1980s. While combinations of these markers are used to predict fetal risk of Down syndrome and other genetic conditions, there is some evidence that individual markers may also predict nongenetic pregnancy complications, particularly those related to placental dysfunction. The objective of this meta-analysis was to investigate the utility of false-positive, second-trimester MSS for Down syndrome as a marker of placentally mediated complications amongst singleton pregnancies globally. Methods Electronic searches of PubMed, Medline, Embase, CINAHL, Web of Science, Scopus, and grey literature to 2019 were performed to identify observational studies comparing risk of pregnancy complications amongst pregnancies with false-positive MSS versus controls. A random-effects model of pooled odds ratios by outcome of interest (stillbirth, preeclampsia, fetal growth restriction, and preterm birth) and subgrouped by type of MSS test (double-, triple-, and quadruple-marker MSS) was used. Results 16 studies enrolling 68515 pregnancies were included. There were increased odds of preeclampsia (OR 1.28, 95% CI 1.09-1.51) and stillbirth (OR 2.46, 95% CI 1.94-3.12) amongst pregnancies with false-positive MSS. There was no significant association with preterm birth or growth restriction. Conclusions There is some evidence of an association between false-positive, second-trimester MSS for Down syndrome and increased odds of preeclampsia and stillbirth. Future large-scale prospective studies are still needed to best determine the predictive value of false-positive MSS as a marker of placentally mediated complications later in pregnancy and evaluate potential clinical interventions to reduce these risks.

MO149PREGNANCY AFTER LIVING KIDNEY DONATION, A SYSTEMATIC REVIEW OF THE AVAILABLE EVIDENCE AND A REVIEW OF THE CURRENT GUIDANCE

Abstract Background and Aims It was long believed that living kidney donation did not infer a risk to the health or longevity of living kidney donors (LKD), though recently, some studies have called this into question. The majority of LKD are women of childbearing age, it is therefore vital that a clear picture of the risks associated with pregnancy post-kidney donation is obtained. Furthermore, it is imperative that the guidance pertaining to accepting an LKD of childbearing age is both comprehensive and clear. We performed a systematic review with the aim of identifying all original research articles examining pregnancy outcomes, such as gestational hypertension and pre-eclampsia in LKD, and to compare the quality and consistency of the guidelines, consensus statements and expert opinions in this area. Method We searched Embase Ovid, MEDLINE Ovid, PubMed, society webpages and guideline registries for English-language publications published up until 18th December 2020. Article references and citation lists were also examined. The study was performed in accordance with the PRISMA guidelines. Results A total of 94 articles were screened. Nine cohort studies, two case reports, and one congress abstract were identified. The four most recent published papers were retrospective cohort studies, which included a combined number of 1,298 LKDs. All four studies reported an increase in both the relative and absolute risk of pregnancy-related complications. For example, the absolute risk of pre-eclampsia increased from ∼1-3% of pregnancies in LKD pre-donation to ∼4-6% of pregnancies in LKD post-donation. This meant that LKDs had a lower absolute risk of pre-eclampsia pre-donation, but after donation their risk of pre-eclampsia matched that of the general population. None of these studies distinguished between early or late onset pre-eclampsia. Participants were predominantly limited to Caucasian women. The lack of an ideal ‘living donor comparator group’ hindered a full quantification (including meta-analysis) of the pregnancy-related complications in LKD. We identified seven clinical guidelines and consensus statements published since 2010. These were broadly consistent in stating that the risk of pregnancy-related complications in LKD was similar to the general population’s risk, and that potential LKD should be informed of this risk. They were however inconsistent in their scope. For example, only three guidelines recommended enquiring into prior pregnancy-induced complications, and only two offered specific guidance on post-donation pregnancy follow-up. The most striking inconsistency was the differing view as to whether or not women who had not yet completed a family should be accepted as LKD. For example, one guideline stated that ‘women should not be excluded from donation solely on the basis of a desire to have children after donation’, whilst another stated that ‘it seem(ed) advisable to have completed a planned family before donation’. Conclusion The relative risk of pregnancy-related complications in LKD increases relative to the risk in non-LKD, though the increase in absolute risk remains very low. Though multiple guidelines for living kidney donation were identified, their advice for women of childbearing age was at times scant and inconsistent. The LKD of the future is likely to differ from the LKD of yesteryear. As such more focus should be placed on better identifying and individualising risk for LKD. Whilst the evidence suggests that an LKD’s risk of complications in pregnancy remains low post donation, one should keep in mind that a potential LKD’s personalised risk is unknown.

Long-Term Cardiovascular Outcomes After Pregnancy in Women With Heart Disease.

BackgroundWomen with heart disease are at risk for pregnancy complications, but their long‐term cardiovascular outcomes after pregnancy are not known.Methods and ResultsWe examined long‐term cardiovascular outcomes after pregnancy in 1014 consecutive women with heart disease and a matched group of 2028 women without heart disease. The primary outcome was a composite of mortality, heart failure, atrial fibrillation, stroke, myocardial infarction, or arrhythmia. Secondary outcomes included cardiac procedures and new hypertension or diabetes mellitus. We compared the rates of these outcomes between women with and without heart disease and adjusted for maternal and pregnancy characteristics. We also determined if pregnancy risk prediction tools (CARPREG [Canadian Cardiac Disease in Pregnancy] and World Health Organization) could stratify long‐term risks. At 20‐year follow‐up, a primary outcome occurred in 33.1% of women with heart disease, compared with 2.1% of women without heart disease. Thirty‐one percent of women with heart disease required a cardiac procedure. The primary outcome (adjusted hazard ratio, 19.6; 95% CI, 13.8–29.0; P<0.0001) and new hypertension or diabetes mellitus (adjusted hazard ratio, 1.6; 95% CI, 1.4–2.0; P<0.0001) were more frequent in women with heart disease compared with those without. Pregnancy risk prediction tools further stratified the late cardiovascular risks in women with heart disease, a primary outcome occurring in up to 54% of women in the highest pregnancy risk category.ConclusionsFollowing pregnancy, women with heart disease are at high risk for adverse long‐term cardiovascular outcomes. Current pregnancy risk prediction tools can identify women at highest risk for long‐term cardiovascular events.

Socio-demographic characteristics and outcomes of pregnant women who delivered prior to and after the termination of the one-child policy in China: a comparative study

BackgroundThe new Chinese fertility policy has recently received widespread public attention. However, there are few studies available on the comprehensive epidemiology of maternal and infant health with respect to the characteristic changes of childbearing women. In the study, we compared the maternal characteristics and pregnancy outcomes at different time points according to policy adjustments, accessed the possible relationship among these factors, and evaluated the impacts of these policies for medical and policy assistance.MethodsThis was a retrospective study. Data were collected from three representative hospitals in Zhejiang Province using stratified random sampling. The annual number of births, and maternal and child healthcare levels were the determining factors of sampling. Women who gave birth in November of 2012, 2014, and 2016 were recruited in accordance with the time of the change in the fertility policy, and we explored the differences in maternal socio-demographic characteristics, delivery mode and pregnancy outcomes.ResultsA total of 11,718 women were recruited, including 3480, 4044, and 4194 in November of 2012, 2014, and 2016, respectively. The proportions of multiparous women, women who aged ≥35 years, who received higher education, who had previous cesarean sections (CS), and who delivered in a high level hospital increased over time. In 2016, multipara accounted for 49.12, 14.47% were aged ≥35 years, nearly half of women had previous CS and delivered in a provincial hospital, 41.73% gave birth by CS, and 31.62% suffered pregnancy complications. The results of multiple logistic regression mode showed CS risk decreased significantly in 2014 (ORadj = 0.62; 95% CI, 0.55–0.67) relative to 2012, and risks of pregnancy complications (ORadj = 2.30; 95% CI, 1.86–2.83) and multiple births (ORadj = 3.25; 95% CI, 2.19–4.83) only increased in 2016 compared to 2012.ConclusionsSome pregnancy outcomes increased as several key characteristics of childbearing women changed after China ended its “one-child” policy. This suggests that policy providers and medical staff need to strengthen healthcare in a consistent fashion regarding changes in birth policy.

Preconceptional Resveratrol Supplementation Partially Counteracts Age-Related Reproductive Complications in C57BL/6J Female Mice.

Aging is associated with a drastic decline in fertility/fecundity and with an increased risk of pregnancy complications. Resveratrol (RES), a natural polyphenolic compound, has shown anti-oxidant and anti-inflammatory activities in both human and animal models, thus representing a potential therapeutic and prophylactic anti-aging supplement. Here, we investigated whether preconceptional resveratrol supplementation improved reproductive outcomes in mid-aged (8-month-old) and old (12-month-old) C57BL/6J female mice. Female siblings were cohoused and assigned to either RES or vehicle supplementation to drinking water for 10 consecutive weeks. Subsequently, females were mated with non-supplemented males and their pregnancy outcomes were monitored. RES improved mating success in old, but not in mid-aged females, and prevented the occurrence of delivery complications in the latter. These results indicate that preconceptional RES supplementation could partially improve age-related reproductive complications, but it was not sufficient to restore fecundity in female mice at a very advanced age.

Association between ambient air pollution and high-risk pregnancy: A 2015–2018 national population-based cohort study in Korea

BackgroundSeveral studies have indicated that prenatal exposure to ambient air pollution is associated with an increased risk of gestational diabetes mellitus, hypertensive disorder during pregnancy, preterm birth, and stillbirth. However, no previous study has focused on the association between the number of pregnancy complications and exposure to ambient air pollution. ObjectivesTo investigate the association between prenatal exposure to ambient air pollutants and the number of pregnancy complications in high-risk pregnancies. MethodsWe collected data on gestational diabetes mellitus, hypertensive disorder during pregnancy, preterm birth, and stillbirth from the National Health Information Databases, provided by the Korean National Health Insurance Service.R To assess individual-level exposure to air pollutants, a spatial prediction model and area-averaging approach were used. ResultsFrom 2015 to 2018, data of 789,595 high-risk pregnancies were analyzed. The ratio of gestational diabetes mellitus in the country was the highest, followed by preterm birth, hypertensive disorder during pregnancy, and stillbirth. Approximately 71.7% of pregnant women (566,143) presented with one pregnancy complication in identical pregnancies, 27.5% (216,714) presented with two, and 0.9% (6738) presented with three or more. Multiple logistic regression models with adjustments for age, residence, and income variables indicated that the risk of having two or more pregnancy complications was positively associated with the exposure to higher levels of PM10 (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.09–1.12) and PM2.5 (OR, 1.14; 95% CI, 1.12–1.15). The highest quartile presented higher odds of two or more pregnancy complications compared with the lower three quartiles of PM10, PM2.5, CO, NO2, and SO2 exposures (p < 0.001). ConclusionThe results indicate that the risk of pregnancy complications is positively associated with the exposure to the high concentrations of PM10, PM2.5, CO, NO2, and SO2.

Depletion of CTCF disrupts PSG gene expression in the human trophoblast cell line Swan 71.

Pregnancy‐specific glycoproteins (PSGs) are fetal proteins secreted by the placenta during pregnancy. The PSG level in maternal serum is an indicator of risk for pregnancy complications. However, little is known about the molecular mechanisms underlying PSG gene expression. Recently, the importance of epigenetic regulation of placental genes has been emphasized in the study of developmental defects and placental disease. In this study, the role of the CCCTC‐binding factor (CTCF) in regulation of PSG expression was investigated to better understand the epigenetic regulatory mechanisms of the PSG genes. Inhibition of CTCF expression disturbed transcription of several PSG genes: PSG1, PSG2, PSG4, PSG5, PSG8, and PSG9 were upregulated and PSG6 and PSG11 were downregulated. These transcriptional changes were correlated with decreased CTCF binding and changes in histone modification at the PSG promoters. Our data demonstrate that CTCF is a potential mediator in the regulation of PSG gene expression.

IMMUNOGENETIC PREDICTORS OF RISK OF MISCARRIAGE

The study of immunogenetic markers associated with the development of complications of pregnancy and perinatal pathology in newborns is of great practical importance for the development of preventive measures and maintaining the health of the baby in the future. Numerous studies in recent years have shown that the presence of genetic predisposition to certain diseases is associated with an increased risk of pregnancy complications (habitual miscarriage, placental insufficiency, late toxicosis), which leads to the implementation of perinatal pathology in later life.

Polycystic Ovarian Syndrome: Impact on Adult and Fetal Health.

Women with the polycystic ovarian syndrome (PCOS) may have an increased risk for complications in pregnancy including miscarriage, gestational diabetes mellitus, hypertensive disorders of pregnancy, higher rates of cesarean delivery, and abnormalities in fetal growth. In addition, PCOS has been associated with the development of type II diabetes mellitus, hypertension, cardiovascular disease, obstructive sleep apnea, endometrial cancer, depression and anxiety, and nonalcoholic fatty liver disease. In understanding that PCOS is a disease impacting more than just a woman's fertility, prevention and early identification of risk factors for affiliated conditions is essential.

Two successful pregnancies in a woman with active acromegaly

Acromegaly is a rare systemic disease, predominantly caused by growth hormone (GH)-secreting pituitary adenoma, leading to insulin-like growth factor-1 (IGF-1) overproduction. Pituitary adenoma extension and/or its treatment can cause infertility or subfertility in both sexes in different mechanisms. Pregnancies in women with active acromegaly are rarely observed but considered generally safe. Growth hormone and IGF-1 concentrations are usually stable during pregnancy and in most cases no significant tumour expansion emerges despite pharmacological therapy withdrawal.&#x0D; A 28 year-old woman with symptoms of acromegaly and amenorrhoea was admitted to the Department of Endocrinology. Diagnosis of acromegaly was made and treatment with somatostatin analogues (SSA) was initiated with subsequent surgical intervention. However, persistent acromegaly was diagnosed post-operatively due to residual tumour and the medical treatment was restarted. During follow-up the patient became pregnant twice and then treatment with somatostatin analogues was ceased. Both pregnancies were complicated by gestational diabetes and in the course of the second pregnancy treatment with dopamine agonist (DA) was commenced to alleviate persistent headaches and it was followed by clinical and biochemical improvement. The patient successfully delivered two healthy babies. After second labour treatment with SSA was resumed and the patient has achieved adequate disease control.&#x0D; The risk of pregnancy complications in women with acromegaly is slightly higher than in general population, especially if uncontrolled disease was present before conception or acromegaly was diagnosed during pregnancy. In rare cases pituitary tumour expansion during pregnancy occurs and then pharmacological or surgical interventions should be considered.

Maternal exercise alters rat fetoplacental stress response: Minimal effects of maternal growth restriction and high-fat feeding

IntroductionFetal growth restriction complicates 10% of pregnancies and increases offspring (F1) risk of metabolic disorders, including obesity and gestational diabetes mellitus (GDM). This disease predisposition can be passed onto the next generation (F2). Importantly, the risk of pregnancy complications in obese women can be exacerbated by a stressful pregnancy. Exercise can reduce adiposity and improve health outcomes in obese women and those with GDM. This study investigated the impacts of maternal growth restriction, obesity, exercise, and stress on fetal and placental endocrine function. MethodsUteroplacental insufficiency (Restricted) or sham (Control) surgery was induced on embryonic day (E) 18 in F0 Wistar-Kyoto rats. F1 offspring were fed a Chow or High-fat (HFD) diet from weaning and, at 16 weeks, were randomly allocated an exercise protocol; Sedentary, Exercised prior to and during pregnancy (Exercise), or Exercised only during pregnancy (PregEx). Females were mated and further randomly allocated to either undergo (Stress), or not undergo (Unstressed), physiological measurements during pregnancy. On E20, F2 fetal plasma (steroid hormones), tissues (brain, liver), and placentae (morphology, stress genes) were collected. ResultsMaternal growth restriction and high-fat feeding had minimal impact on fetoplacental endocrine function. PregEx and Exercise increased cross-sectional labyrinth and junctional zone areas. PregEx, but not Exercise, increased fetal deoxycorticosterone concentrations and reduced placental Hsd11b2 and Nr3c2 gene abundance. Maternal stress increased fetal corticosterone concentrations in Sedentary HFD dams and increased placental cross-sectional areas in PregEx mothers. DiscussionPregEx and Stress independently dysregulates the endocrine status of the developing fetus, which may program future disease.

Pregnancy complications among nulliparous and multiparous women with advanced maternal age: a community-based prospective cohort study in China

BackgroundThis study aimed to evaluate the incidence rates and risks of pregnancy complications among nulliparous and multiparous women with advanced maternal age (AMA, ≥35 years) in China.MethodsWe performed a community-based prospective cohort study of 10,171 pregnant women in selected two sub-districts and 11 towns of Liuyang from 2013 to 2015. All subjects were followed up from the first prenatal care (at ≤12 weeks) to delivery, and risks of pregnancy complications were compared by parity and maternal age groups.ResultsAmong nulliparas, women with AMA showed significantly increased risks for gestational hypertension (OR 8.44, 95%CI 1.68–2.88), preeclampsia/eclampsia (OR 9.92, 95%CI 4.87–18.78), premature rupture of membrane (OR 6.84, 95%CI 2.00–17.69), as compared to women in the 20–29-year age group. Among multiparas with AMA, increased risks were found for gestational diabetes mellitus (OR 3.29, 95%CI 1.76–5.94), anemia (OR 1.85, 95%CI 1.25–2.69), polyhydramnios (OR 3.29, 95%CI 1.56–6.64), premature rupture of membrane (OR 5.14, 95%CI 2.12–12.29), and preterm labor (OR 1.89, 95CI 1.42–2.50).ConclusionsWomen with AMA were associated with increased risks of pregnancy complications, and complications with increased risks differed in nulliparas and multiparas. Women with AMA should be identified as a high-risk group in clinical practice.

THE EFFECT OF SMOKING ON PREGNANCY COMPLICATIONS IN WOMEN WITH THE POLYCYSTIC OVARIAN SYNDROME (PCOS): A STUDY OF ALMOST 15,000 WOMEN

The risk of pregnancy complications in patients PCOS is increased, including; pregnancy induced hypertension, preeclampsia, preterm birth and gestational diabetes mellitus (GDM). In the non PCOS population, prenatal smoking is associated with preterm birth, placental abruption, intra-uterine growth restriction and an inverse relationship with pregnancy induced hypertension (PIH). It remains unclear whether an association between smoking and GDM exists with studies reporting confliction results. We sought to investigate whether there is an association between pregnancy complications and smoking in women with PCOS.

Contraceptive practices in women with chronic medical conditions

Contraception in women with severe medical conditions is a potential measure to reduce maternal mortality. We sought to determine the contraceptive use in women with medical conditions at the University Hospital of the West Indies (UHWI) in Jamaica to determine if there is room for improvement in contraceptive use. Participants were identified from the medical out-patient departments and questionnaires administered. Two hundred and sixty females between 18 and 44 years with varied chronic medical conditions were included. Those included were systemic lupus erythematosus (SLE), diabetes, hypertension (HTN), thyroid disease, cardiac and renal disease. The total current use of contraception was 58.4%, while 41.6% were not on contraceptives. The use of barrier methods and long-acting reversible contraceptives (LARCs) was 71% and 10%, respectively. The current use of contraception in patients with sickle cell disease (SCD) was 84% (p=.004) and in rheumatoid arthritis (RA), 14% (p=.028). Fifty-eight (58, 24.2%) of the women were using two or more methods of contraception. There is a role for improving contraceptive use among women with medical conditions as they are at increased risk of pregnancy complications. IMPACT STATEMENT What is already known on this subject? Women with medical comorbidities significantly contribute to both direct and indirect causes of maternal mortality. Contraception may play an integral role in reducing the risk of dying in chronically ill women; however, the use of contraception in this group is often suboptimal. What the results of this study add? This study adds to the literature that in this high-risk group, there is an underuse of long-acting reversible contraceptives, which is ideal for this population. What the implications are of these findings for clinical practice or further research? The results will provide evidence that this high-risk group of women should be targeted and counselled regarding their risk of morbidity and mortality in pregnancy as well as contraception use while their condition is optimised. From this evidence, services may be put in place in institutions, especially in low-resource settings.

Should the patients with endometriosis be treated as a risk group of pregnancy complications? Single center experience and literature review and literature review.

Multidirectional influence of endometriosis on fertility impairments is well known. Altered implantation and placentation among affected patients raised concerns regarding possible negative influence on the course of pregnancy. The primary objective of the study was to assess the course of gestation and the incidence of pregnancy complications among women with endometriosis. It also aimed to determine whether the method of conception might impact the primary results. A single-center cohort study included 64 women with confirmed endometriosis and 296 healthy controls. Data concerning treatment of endometriosis related infertility, course of pregnancy and perinatal outcomes were evaluated. Patients with endometriosis were older than controls (33.6 +/- 4.2 y vs 31.8 +/- 4.6, p = 0.01) and more often gave birth for the first time (87.5% vs 43.9%, p = 0.001). The age at the time of first delivery was significantly higher within the study group (33.1 y +/- 4.1 vs 29.9 +/- 4.6, p < 0.001). In the study, 81.2% of patients with endometriosis had the diagnosis of infertility. Patients suffering from endometriosis were significantly more prone to spontaneous placental abruption during pregnancy and delivery (4.7 vs 0.3%, odds ratio = 14.5). Several complications occurred more often in endometriotic patients (gestational diabetes mellitus, small-for-gestational-age and anemia); however, without statistical significance. The risk of pregnancy complications was independent from stage of endometriosis and way of conception. The incidences of adverse neonatal outcomes (preterm delivery, low Apgar score, lower birth weight) were similar in both groups. Endometriosis may adversely affect perinatal outcomes, especially due to increased risk of placenta abruption and operative delivery. Stage of endometriosis and method of conception does not enhance these complications.

The role of the IL-1 system in pregnancy and the use of IL-1 system markers to identify women at risk for pregnancy complications†.

The interleukin (IL)-1 system plays a major role in immune responses and inflammation. The IL-1 system components include IL-1α, IL-1β, IL-1 receptor type 1 and IL-1 receptor type 2 (decoy receptor), IL-1 receptor accessory protein, and IL-1 receptor antagonist (IL-1Ra). These components have been shown to play a role in pregnancy, specifically in embryo-maternal communication for implantation, placenta development, and protection against infections. As gestation advances, maternal tissues experience increasing fetal demand and physical stress and IL-1β is induced. Dependent on the levels of IL-1Ra, which regulates IL-1β activity, a pro-inflammatory response may or may not occur. If there is an inflammatory response, prostaglandins are synthesized that may lead to myometrial contractions and the initiation of labor. Many studies have examined the role of the IL-1 system in pregnancy by independently measuring plasma, cervical, and amniotic fluid IL-1β or IL-1Ra levels. Other studies have tested for polymorphisms in IL-1β and IL-1Ra genes in women experiencing pregnancy complications such as early pregnancy loss, in vitro fertilization failure, pre-eclampsia and preterm delivery. Data from those studies suggest a definite role for the IL-1 system in successful pregnancy outcomes. However, as anticipated, the results varied among different experimental models, ethnicities, and disease states. Here, we review the current literature and propose that measurement of IL-1Ra in relation to IL-1 may be useful in predicting the risk of poor pregnancy outcomes.

1341-P: Comparison of the Effects of Metformin and Exenatide on Pregnancy Rate and Outcomes in Overweight or Obese PCOS Women

The majority of PCOS are overweight or obese (OW/OB) with increased infertility and risk of pregnancy complications. Evidences show that in PCOS, metformin and exenatide have impact on insulin resistance and body weight with seldom information about pregnancy and its outcome. This study was designed directly to compare the effect of two treatments on pregnancy rate and outcomes in OW/OB PCOS. This prospective clinical trial randomized 160 OW/OB PCOS with infertility, without diabetes into metformin and exenatide treatment for the first 12 weeks. Afterward, all were treated with metformin alone until week 52. If patients failed spontaneous pregnancy during the second 12 weeks, assisted reproduction technique (ART) could be offered until week 52. The spontaneous and total pregnancy rates were recorded within 52 weeks. Pregnancy outcomes were followed until the deliveries. Baseline characteristics were similar between two groups. At week 24, higher spontaneous pregnancy rate was observed in exenatide group, although at week 52, the total pregnancy rates were similar between two groups. Meanwhile, no significant difference of pregnancy outcomes was implicated between two groups (Table 1). In OW/OB PCOS, 12 weeks exenatide treatment had improved spontaneous pregnancy rate compared with metformin treatment, without benefit effects on total pregnancy rate and overall pregnancy outcomes. Disclosure R. Li: None. S. Zheng: None. T. Mai: None. J. Xue: None. Y. Zhang: None. Funding National Natural Science Foundation of China (81200607)

Obesity among women of reproductive age using contraceptive methods in Port Harcourt, Nigeria

Obesity predisposes pregnant women to increased risk of pregnancy complications for mother and fetus. Avoiding unintended pregnancy among obese women is therefore of major importance, given the increased risks associated with pregnancy. This study determined the prevalence of obesity among female contraceptive users in the University of Port Harcourt Teaching Hospital. This was a cross-sectional study among randomly selected married non-pregnant women of reproductive age attending the Family Medicine clinic. Data was collected using a specially designed structured questionnaire and analysed using SPSS version 20. The p-value of less than 0.05 was used as the criterion for significance. A total of 422 randomly selected participants who satisfied the inclusion and exclusion criteria were studied. Their age range was 15-49 years with a mean of 32.86 ± 6.85 years. Majority of the respondents (60.7%) had 13-18 years of formal education. The contraception prevalence among obese participants was 37.2%. The barrier method was the most commonly used (32.6%). There was no association between contraceptive use and the participants’ Body Mass Index (p= 0.730). The prevalence of obesity among contraceptive users was 37.2%. The barrier method was the most commonly used method. Although there was no association between contraceptive use and obesity, primary care providers including family physicians should educate women on the adverse effect of obesity on the general health of women.

Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents

BackgroundExcess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity.MethodsThe current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography.DiscussionThis pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring.Trial registrationClinicalTrials.gov NCT03086161, retrospectively registered