Trimester Visit Research Articles

Abstract 16315: Associations Between Angiogenic Biomarkers in Early Pregnancy and Predicted 30-year Risk of Cardiovascular Disease 2-7 Years After Delivery

Introduction: The placenta is a vascular organ that secretes angiogenic proteins during pregnancy. Abnormalities in these biomarkers are associated with higher risk for adverse pregnancy outcomes, which include hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM). However, the association between abnormalities in angiogenic proteins and long-term CVD risk is uncertain. Aims: To determine the association between angiogenic placental proteins measured in early pregnancy and predicted 30-year risk of CVD 2-7 years after delivery. Methods: In this analysis, we included nulliparous individuals from the prospective multicenter nuMoM2b Heart Health Study (nuMoM2b-HHS) with available data on angiogenic protein concentrations in the first trimester (vascular endothelial growth factor [VEGF], placental growth factor [PlGF], endoglin, and soluble fms-like tyrosine kinase-1 [sFLT-1]). The primary outcome was predicted 30-year risk of CVD based on the Framingham model, which integrates traditional risk factor levels into an absolute risk estimate. Multivariable linear regression estimated associations between log-transformed angiogenic protein concentrations and predicted 30-year risk of CVD, adjusting for maternal age, gestational age, insurance type, and smoking status at the first trimester visit. Analyses were repeated stratified by HDP or GDM. Results: Of 987 nuMoM2b-HHS participants included, the mean age was 26.9 (SD 5.9) years and the mean gestational age at biomarker assessment was 11.4 (1.6) weeks. Higher log-transformed concentrations of VEGF (per 1-SD) were associated with greater predicted 30-year risk of CVD by 0.68% (0.34, 1.02). Conversely, higher log-transformed concentrations of endoglin and sFlt-1 were associated with lower 30-year predicted risk of CVD by 0.85% (-1.15, -0.55) and 0.70% (-1.00, -0.41), respectively. There was no association between PlGF and 30-year predicted risk of CVD. Results were similar in those with or without HDP or GDM. Conclusions: Concentrations of VEGF, endoglin, and sFLt-1 measured in early pregnancy were associated with predicted long-term risk of CVD 2-7 years after delivery in all birthing individuals whether or not they experienced an adverse pregnancy outcome.

Vaccination choices among pregnant women: findings from the MAMI-MED cohort

Abstract Background According to the Italian National Immunization Plan 2023-2025, vaccinations against Measles, Mumps, Rubella (MMR), Varicella and Human Papillomavirus (HPV) are indicated for women of childbearing age. During pregnancy, vaccination against Diphtheria, Tetanus, and Pertussis (DTaP), and Seasonal Influenza are recommended. The present analysis aimed to estimate vaccination choice and its main determinants among pregnant women. Methods We used data from the “MAMI-MED” cohort, an ongoing prospective study on mother-child dyads established in December 2020. Socio-demographic information (i.e., age, educational level and employment) were assessed at enrollment, during the first trimester visit at the Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima (Catania, Italy). Self-reported maternal vaccination status was collected at delivery. Results Among 1004 women with a complete vaccination assessment, 83.5% were vaccinated against MMR, 87.4% against DTaP, 68.3% against Varicella, while only 23.7% and 9.4% against HPV and Seasonal Influenza, respectively. During pregnancy, only 8.7% and 21.1% of women were vaccinated against DTaP and Seasonal Influenza, respectively. The lack of information was the main ground for refusal, accounting for 93.7% for HPV, 82.5% for Influenza, 64.7% for DTaP, 31.8% for MPR, and 18.9% for Varicella. Women vaccinated against HPV and MMR were younger than their unvaccinated counterpart (p < 0.001 and p = 0.023, respectively). The logistic regression showed that the odds of being vaccinated against HPV increased with increasing age, adjusting for education and employment (OR = 1.12; 95% CI = 1.09-1.16; p < 0.001). Conclusions The analysis showed modest vaccination coverages, mainly depending on the lack of information about vaccination programs. Moreover, we observed that younger women were more aware of HPV vaccination, which probably reflects improvements in the national vaccination program over the years. Key messages • It is necessary to increase knowledge about vaccination among women in the reproductive age. • Social determinants should be assessed to understand the barriers that might affect vaccination choice.

Obstetric Complications and Adverse Birth Outcomes among Adolescent and Adult Pregnant Women in Dhaka, Bangladesh

Background and Objective: The current study aimed to determine the association of maternal age and obstetric complications and adverse birth outcomes among the adolescent and adult pregnant women.
 Methods: A cross-sectional study was conducted involving about 150 pregnant women (75 adolescent and 75 adult) who were purposively selected from three maternity centers of Dhaka city. All of them were primigravida experiencing their third trimester of pregnancy. They were interviewed twice (first visit during third trimester and second visit after delivery) with a semi-structured questionnaire. Statistical analysis was done by IBM SPSS Statistics version 20.0. Adjusted odds ratios were achieved by conducting binomial logistic regression analysis.
 Results: The mean age of the adolescent pregnant girls and adult pregnant women were 16.54±2.38 and 25.23±5.67 years of age, respectively. It was explored that adolescent pregnant girls had higher risks for anemia, preeclampsia, eclampsia, severe fever, jaundice, abnormal position of the baby and urinary problems during gestation. On the contrary, they were observed with lower risks for gestational diabetes, excessive bleeding and leakage of amniotic fluid during pregnancy. During delivery, adolescent group had higher risks for excessive bleeding and placental abruption. Findings of the study also showed that pregnant adolescents had higher risks of various adverse birth outcomes like preterm delivery, still birth, small for gestational age (SGA), very low birth weight (LBW), and low birth weight (LBW).
 Conclusion: Adolescent pregnancy in Dhaka city had augmented the risk of obstetric complications during pregnancy, during delivery as well as adverse birth outcomes.

Sex-specific effects of prenatal organophosphate ester (OPE) metabolite mixtures and adverse infant birth outcomes in the maternal and developmental risks from environmental and social stressors (MADRES) pregnancy cohort

BackgroundOrganophosphate esters (OPEs) are used as flame retardants and plasticizers in various consumer products. Limited prior research suggests sex-specific effects of prenatal OPE exposures on fetal development. We evaluated overall and sex-specific associations between prenatal OPE exposures and gestational age (GA) at birth and birthweight for gestational age (BW for GA) z-scores among the predominately low-income, Hispanic MADRES cohort. MethodsNine OPE metabolite concentrations were measured in 421 maternal urine samples collected during a third trimester visit (GA = 31.5 ± 2.0 weeks). We examined associations between single urinary OPE metabolites and GA at birth and BW for GA z-scores using linear regression models and Generalized Additive Models (GAMs) and effects from OPE mixtures using Bayesian Kernel Machine Regression (BKMR). We also assessed sex-specific differences in single metabolite analyses by evaluating statistical interactions and stratifying by sex. ResultsWe did not find significant associations between individual OPE metabolites and birth outcomes in the full infant sample; however, we found that higher bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) was associated with earlier GA at birth among male infants (p = 0.04), and a nonlinear, inverted U-shape association between the sum of dibutyl phosphate and di-isobutyl phosphate (DNBP + DIBP) and GA at birth among female infants (p = 0.03). In mixtures analysis, higher OPE metabolite mixture exposures was associated with lower GA at birth, which was primarily driven by female infants. No associations were observed between OPE mixtures and BW for GA z-scores. ConclusionHigher BDCIPP and DNBP + DIBP concentrations were associated with earlier GA at birth among male and female infants, respectively. Higher exposure to OPE mixtures was associated with earlier GA at birth, particularly among female infants. However, we saw no associations between prenatal OPEs and BW for GA. Our results suggest sex-specific impacts of prenatal OPE exposures on GA at birth.

Integration of multiomics with precision nutrition for gestational diabetes: Study protocol for the Westlake Precision Birth Cohort

Integration of multiomics with precision nutrition for gestational diabetes: Study protocol for the Westlake Precision Birth Cohort

Pre-Pregnancy Adherence to Mediterranean Diet and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Greece.

Gestational Diabetes Mellitus (GDM) is a growing epidemic affecting pregnant women and their offspring. This study aimed to identify the relationship between adherence to a Mediterranean diet (MD) before conception and the risk of GDM in a contemporary Greek pregnant cohort. A prospective cohort of pregnant women was recruited at the routine first trimester visit. Nutritional intake was evaluated using a population specific validated food frequency questionnaire (FFQ). Pre-pregnancy adherence to MD was derived using two different scoring systems, the Mediterranean diet index score (MDS), and a modified version. Adjusted odds ratios (aOR) were computed using multiple logistic regression models for each score derived. Of 743 participating women, 112 (15.1%) developed GDM. The MDS index showed that scoring 5-9 points (high adherence) was associated with a lower GDM incidence (aOR: 0.57 95% CI (0.32, 0.90), p = 0.02), while the modified MDS index showed no significant association for any level of adherence. Pre-pregnancy consumption of "meat and derivatives" and "fatty meat and processed meat" was associated with a higher risk of GDM, with both scoring systems (p = 0.008, p = 0.004, respectively). A higher adherence to a MD pre-pregnancy, especially with less meat consumption, may have a protective effect on the occurrence of GDM.

Racial Disparities in Screening and Management of Anemia Among Pregnant Women

Background: Iron deficiency anemia (IDA) in pregnancy is common in the United States, with an overall prevalence of 18%. ACOG and CDC guidelines recommend screening for anemia be done at the first prenatal visit with a CBC. IDA in pregnancy is associated with several adverse fetal and maternal health outcomes, including pre-term birth and low birth weight. Studies are just beginning to emerge describing racial disparities associated with assessment and management of IDA in pregnancy. Our primary objective in this study is to investigate the screening practices for anemia in pregnant women at our institution. Further objectives include investigating potential racial disparities in screening practices and management for anemia in pregnant women. Methods: We performed a retrospective cohort study of all pregnant women, aged 13-50 years old, who delivered at the University of Michigan (UM) between July 2015 and January 2022, and who received prenatal care at UM beginning the first trimester of pregnancy. After IRB approval, data were collected from the UM electronic medical record, MiChart. Inclusion in the cohort was based on CPT codes for delivery; first trimester visit was defined based on calculation from last menstrual period to 13 weeks of gestation. We used a t-test to compare mean hemoglobin (Hgb) and mean corpuscular volume (MCV) in Caucasian and African American women. We defined anemia as Hgb <10.5 g/dL during any point in pregnancy. We used Chi-square analysis to compare the proportion of Caucasian and African American women screened for anemia with Hgb and screened for iron deficiency with ferritin and transferrin saturation. Chi-square analysis was also used to compare the proportion of women prescribed iron supplementation. Results: A total of 16,073 pregnant women were included in the study, with 1,781 (11.08%) self-reported African Americans, 11,590 (72.11%) Caucasians, 1,472 (9.16%) Asians, and 1,230 (7.65%) women of other races/unknown. While screening for anemia was very common in our cohort, Caucasian women were slightly more likely to be screened for anemia than African American women (98.88% vs. 97.47%, p <0.001); see Table 1 below. Overall, 23.87% of women in our cohort were anemic at some point during pregnancy. Anemia was more common among African American women compared to Caucasian women (39.79% vs 21.41%, p <0.001). The mean Hgb was significantly higher in Caucasians versus African Americans (11.63 g/dL, SD 1.58 vs. 10.84 g/dL, SD 1.62, p <0.001). Mean MCV was lower in African Americans than Caucasians (85.94 fL, SD 6.63 vs. 89.04 fL, SD 5.12, p <0.001). African American women were more likely to be tested for iron deficiency compared to Caucasian women using ferritin (1.12% vs. 0.53%, p <0.001), and transferrin saturation (1.12% vs 0.44%, p <0.001). In terms of anemia management, 31.05% of patients overall were prescribed iron supplementation (oral or IV forms). African American women were more likely to be prescribed supplemental iron compared to Caucasian women (45.65% vs. 28.81%, p <0.001). Conclusion: Overall screening for anemia among pregnant women is very common among patients in our cohort, in congruence with guideline recommendations. Even though only a small proportion of patients did not have a Hgb checked during pregnancy, African American women were less likely to be screened for anemia during pregnancy compared to Caucasian women. In our cohort, pregnant African American women were more likely to be anemic, with a lower mean Hgb level and MCV compared to Caucasian women. Interestingly, although approximately one in four women were found to be anemic overall, less than 1% of women in our cohort had laboratory testing with ferritin or transferrin saturation to further work up iron deficiency. Despite this, nearly one third of patients received a prescription for iron supplementation. This suggests a frequent practice at our institution of empirically prescribing iron supplementation in the absence of laboratory work up for iron deficiency, especially among African Americans. Next steps include further evaluation as to whether this is an effective approach to treating anemia in pregnancy, or whether additional anemia work up is warranted in this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Phthalate and bisphenol a exposures during pregnancy: Findings from the National Children's Study

Maternal exposure to phthalates and bisphenol A (BPA) during pregnancy can result in many adverse offspring health outcomes. Exposure to phthalates and BPA can vary depending on consumption of certain foods, some of which may vary by race/ethnicity. This study relates urine phthalate and BPA concentrations to sociodemographic and diet data. Concentrations of bisphenol A (BPA) and 11 phthalate metabolites were measured from spot urine at the third trimester visit of a sample of 485 pregnant women from the National Children's Study Vanguard Study Pilot data from seven U.S. cities. At the same time, food frequency questionnaires (FFQ) using the Diet*Calc software were obtained from 313 (65%) participants to assess dietary behavior. Overall, phthalate metabolites were highest among Hispanic women, particularly mBP, miBP, and mECPP, and these disparities were not explained by diet. Participants who did not attend college had higher concentrations of mBP, mBzP, mEP, and miBP, and lower mCOP. These disparities were also not explained by diet. The causes for these disparities should be further studied to reduce potential negative health outcomes associated with phthalate exposure for children of Hispanic or non-college educated women.

Hydroxychloroquine in the pregnancies of women with lupus: a meta-analysis of individual participant data

ObjectiveMultiple guidelines recommend continuing hydroxychloroquine (HCQ) for SLE during pregnancy based on observational data. The goal of this individual patient data meta-analysis was to identify the potential benefits and harms...

Single-step DIPSI 75g Glucose Tolerance Test-For Diagnosis of Gestational Diabetes Mellitus

Background: Gestational Diabetes Mellitus (GDM) refers to glucose intolerance diagnosed at onset or first recognition during pregnancy. Women with GDM are at risk for maternal and foetal complications, so it is important to screen all pregnant women. The present study was carried out to determine the significance and use of the 75 g Oral Glucose Challenge Test (OGCT) using the Diabetes in Pregnancy Study Group India (DIPSI) criteria for screening of GDM. Objectives: This study was planned to analyze the incidence of GDM in pregnant women attending antenatal care clinic, using DIPSI criteria 75 g OGCT in the first trimester or at the first antenatal visit. Methods: In this prospective observational study, 451 pregnant women attended the antenatal clinic for the first visit at gestation between 6 and 20 weeks. 75 g oral glucose is administered irrespective of whether she is in the fasting or non-fasting state, without regard to the time of the last meal and GDM was diagnosed, and treatment started. Maternal and fetal outcomes were measured. Results: The incidence of GDM using DIPSI criteria (&gt;140 md/dL) was 20.8% in the first trimester or first antenatal visit. Incidence of maternal and foetal complications was lower in our study when compared to other studies. Conclusion: It is concluded that a 75 g glucose challenge test at 6-20 weeks of gestation with a cut-off value of 140 mg/dl is a reliable screening test for GDM. Keywords: Gestational diabetes mellitus; Oral glucose challenge test (OGCT); Glucose intolerance; DIPSI criteria

Continuous glucose monitoring and insulin pump therapy in pregnant women with type 1 diabetes mellitus.

We examined the impact of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGM) during pregnancy in women with pre-gestational type 1 diabetes (T1DM) on glycemic control and subsequent adverse outcomes. In this observational, one-center study we analyzed records of consecutive 109 T1DM pregnancies (2016-2017). The final analyzed group consisted of 81 singleton pregnancies who met inclusion and exclusion criteria. We searched for the association between the use of CSII with or without CGM and pregnancy planning with glycated hemoglobin A1c (HbA1c) through pregnancy and after delivery as well as maternal and infant outcomes. Patients using CSII and CGM vs CSII without CGM and MDI (multiple daily injections) users had the lowest HbA1c levels during and after pregnancy (5.3%, 5.3%, 5.2% and 5,5% in the 1st, 2nd, 3rd trimester and postpartum visit, p = 0.003, p = 0.030, p = 0.039 and p = 0.002, respectively). Patients treated with insulin pumps with CGM and additional functions of automatic insulin delivery suspension on low glucose level (SLG) or predictive low glucose suspend (PLGS) during the third trimester and after pregnancy achieved a significantly lower HbA1c than the other CSII patients. We did not find any differences between the study groups in gestational age at delivery, preterm births, birth weight or macrosomia risk. Despite very good glycemic control, the risk of macrosomia remained high (19.7%). The use of pumps equipped with CGM, especially with automatic insulin delivery suspension, may improve glycemic control in pregnant T1DM women. The proportion of macrosomia remained high.

Early-pregnancy maternal body mass index is associated with common DNA methylation markers in cord blood and placenta: a paired-tissue epigenome-wide association study

ABSTRACT Women entering pregnancy with elevated body mass index (BMI) face greater risk of adverse outcomes during pregnancy, delivery, and for their offspring later in life, potentially via epigenetics. If epigenetic programming occurs early during in utero development, the differential marks should be detectable in multiple tissues despite the known unique epigenetic profile in each. We used early-pregnancy BMI as reflection of maternal metabolic milieu exposure in peri-conception and early-pregnancy period. We analysed DNA methylation in paired cord blood and placenta samples among 437 newborns from Gen3G, a pre-birth prospective cohort of primarily European descent. We measured DNA methylation in both tissues across the genome in >720,000 CpG sites using the Illumina MethylationEPIC array. At each site, we used linear mixed models (LMMs) with an unstructured variance-covariance matrix to test for an association between maternal early-pregnancy BMI and DNA methylation in both tissues (modelled as M-values). We adjusted for tissue-specific covariates, offspring sex, gestational age at delivery, and maternal smoking and age. Women had a mean (SD) BMI of 25.4 (5.7) kg/m2 measured at first trimester visit (mean=9.9 weeks). Early-pregnancy BMI was associated with differential DNA methylation levels in paired-tissue analyses at two sites: cg10593758 (β=0.0126, SE=0.0025; P=4.07e-7), annotated to CRHBP, and cg0762168 (β=−0.0094, SE=0.0018; P=2.78e-7), annotated to CCDC97. Application of LMMs in DNA methylation data from distinct fetal-origin tissues allowed us to identify CpG sites at which early-pregnancy BMI may have an epigenetic ‘programming’ effect on overall fetus development. One site (CRHBP) may play a role in hypothalamic-pituitary-adrenal axis regulation.

The effect of obesity in pregnancy and gestational weight gain on neonatal outcome in glucose-tolerant mothers.

BackgroundMost studies showing association between mothers with obesity in pregnancy or excessive gestational weight gain (GWG) and adverse neonatal outcome were cross‐sectional or retrospective. Many included patients are with gestational diabetes mellitus (GDM), which is a strong risk factor for this adverse outcome. There are no prospective studies on this topic in Malaysia. This study aimed to examine prospectively the effects of obesity in pregnancy and GWG, independent of GDM, on neonatal outcome.MethodsPregnant mothers in the first trimester, who presented to health clinics in Kuching, were screened. Mothers with existing diabetes mellitus or GDM were excluded using 75‐g oral glucose tolerance test during the first and second trimesters. Participants with the first trimester BMI ≥ 23 kg/m2 were recruited as overweight/obese group, whereas those with BMI 18.5–22.9 kg/m2 were taken as the comparison group. At every trimester visit, mothers' weights were recorded. Babies' birth weight and occurrence of adverse neonatal outcome were documented.ResultsThere were 123 mothers recruited as overweight/obese group (mean BMI 29.0 kg/m2 ± 4.45) and 102 mothers as comparison group (mean BMI 20.4 kg/m2 ± 1.48). The number of low birth weight was similar between groups: 9.8% in overweight/obese group, 6.9% in the comparison group (p = 0.416). More than half of these babies were born to mothers with inadequate GWG (58.3% in obese group vs. 57.1% in control group, p = 0.077). There was no significant difference in the mean birth weight (3000 g ± 454.5 vs. 3038 g ± 340.8, p = 0.471), preterm delivery (8.13% vs. 3.92%, p = 0.193), and admission rate to neonatal intensive care unit (8.13% vs. 7.85%, p = 0.937) between groups. There was a positive correlation between the total GWG in overweight/obese group on baby's weight (r = 0.222, p = 0.013). Inadequate GWG was not correlated with lower birth weight (p = 0.052).ConclusionsObesity in pregnancy was not associated with poor neonatal outcome in this small sample of women in Malaysia. Total GWG showed a weak correlation with baby's birth weight in overweight/obese group.

A180 RISK FACTORS FOR INADEQUATE GESTATIONAL WEIGHT GAIN IN PREGNANT PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Abstract Background Patients with inflammatory bowel disease (IBD) are at a risk of inadequate gestational weight-gain (GWG) which in turn may increase the risk of adverse pregnancy outcomes. Aims To determine the risk factors for inadequate GWG in these patients and to determine the impact on adverse pregnancy outcomes. Methods Pregnant patients with IBD, both ulcerative colitis (UC) and Crohn’s disease (CD), were identified retrospectively at the Mount Sinai Hospital from 2016 to 2020. Total gestational weight-gain (GWG) was calculated as the difference of the weight recorded at time of labor and pre-pregnancy weight. GWG was further stratified into less than adequate, adequate, and more than adequate based on the pre-pregnancy body-mass index and standards set by the U.S. Institute of Medicine. Pregnancy-related outcomes were also recorded for each patient. Disease activity was recorded at each trimester visit and defined by a fecal calprotectin (FCP) &amp;gt; 250 ug/g. Differences in the mean GWG were compared using independent T-test with standard deviations (SD) whereas categorical variables were compared using the Chi-square (x2) test. Results 71 pregnancies in 71 patients were included (33 UC and 38 CD). Thirteen patients (18.3%) had less than adequate, 23 (32.4%) adequate, and 35 (49.3%) more than adequate GWG. Of the 33 patients with UC, 4 (12.2%) had less than adequate, 15 (45.5%) had adequate, and 14 (42.4%) had more than adequate GWG. Of the 38 patients with CD, 9 (23.7%) had less than adequate, 8 (21.1%) had adequate, and 21 (55.3%) had more than adequate GWG (p=0.07) for CD vs. UC). In those with CD, both fistulizing and stricturing CD phenotypes appeared to be numerically associated with inadequate GWG. Specifically, none of the 13 patients with fistulizing CD had adequate GWG compared to 32.0% (8/25) in those without fistulizing disease (p=0.07). Similarly, only 2/22 (9.1%) of those with stricturing CD had adequate GWG compared to 6/16 (37.5%) in those without stricturing disease (p=0.07). Furthermore, of seven patients with active disease in the first trimester, only one had adequate GWG (14.3%) compared to 37.5% (3/8) of those in clinical remission (p=0.044). Active disease in trimesters two and three was not associated with inadequate GWG. Finally, the mean GWG was higher in those undergoing Cesarean (37.8 kg (SD 14.1) vs. 30.4 kg (SD 10.5), p=0.014)) and emergency Cesarean delivery (43.5 kg (SD 17.6) vs. 31.9 kg (SD 10.7) (p=0.004) compared to vaginal delivery respectively. Conclusions Patients with CD, but not UC, and those with active disease in the first trimester, are at risk of inadequate GWG during pregnancy. In those with larger GWG, a higher rate of emergency Cesarean birth was noted. Optimal intervention to achieve recommended gestational weight-gains in patients with IBD remains to be determined. Funding Agencies None

Hubungan Kunjungan Trimester 1 dengan Screening Anemia pada Ibu Hamil di Era Peradaban Baru

The Covid-19 pandemic gave birth to a new civilization era where people were asked to adapt to this pandemic condition. This also applies to maternal and child health services, especially antenatal care. The highest cause of death in Indonesia in 2019 is due to bleeding, which can be influenced by low hemoglobin levels or what is commonly known as anemia. The purpose of this study was to analyze the relationship between first trimester visits and anemia screening in pregnant women. The research method used was cross sectional, using google form media to fill out questionnaires and screen shots of the MCH book. The statistical test in this study used Pearson. The results showed that there was no relationship between the first trimester visit and anemia screening, which was obtained by the Pearson statistical test value sig = 0.189&gt; 0.05, which means that there was no relationship between the first trimester visit and the examination of hemoglobin levels in pregnant women. The conclusion that can be drawn is that even though we are now entering a new civilization era where there are several regions that implement Large-Scale Social Restrictions and which in Maternal and Child Health services, especially pregnancy examinations, can still be implemented, government policies in the new civilization era during the 1st trimester visit are focused on screening of maternal health conditions for complications in pregnancy, and especially regarding referrals if there are complications in her pregnancy and management of pregnant women with Covid-19, so that this can prevent transmission of Covid-19.

872 Racial differences in spiral artery remodeling

Maternal race is a determinant of the frequency and severity of ischemic placental disease. Current Doppler methods infer, but do not directly assess, function of the spiral arteries (SA), the root of placental dysfunction. We developed a novel ultrasound method combining B-flow, spatiotemporal image correlation (STIC) and M-Mode to image and measure SA intraluminal diameter during the maternal cardiac cycle in both systole (S) and diastole (D)(Fig 1). We tested the hypothesis that measurable SA function differs between races. In an IRB-approved prospective longitudinal observational study, we defined a supernormal population (parity=0, no co-morbidities or pregnancy complications) to control covariables. S and D were quantified in all trimesters, with a compound ultrasound technique: In B-flow mode, STIC/4D image blocks of individual SA were acquired systematically in the placental bed. S and D diameters were measured via M-Mode. At the first trimester visit, serum analytes (PAPP-A, PlGF, AFP) were obtained. At each visit, BMI, mean arterial blood pressure, mean uterine artery-PI, gestational age (GA), race and age were recorded. Quality control included formal training, written criteria for image acceptance and screening of every image by senior study personnel, all blinded to patient characteristics/outcome. Longitudinal analysis utilized a linear mixed-effects model with random intercept and random slope. A total of 645 SA were measured serially in 43 women (15 each) at 11-32 weeks. Women self-assigned race as Black (24), White (14) or Asian (5). S and D diameters rose with GA (p<0.001 for both). S was significantly higher in W than B and A (Fig 2) The model showed significant interaction between S and PAPP-A (p<0.0001). The study shows B-flow/M-mode can detect and quantify SA remodeling and illustrates the normal loss of mural tone of these vessels as pregnancy advances. Even when pregnancy outcome is normal, black women show less remodeling, a potential clue to their liability for placental dysfunction across pregnancy and the puerperium.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

682 Everything in moderation: impact of extremes of BMI & gestational weight gain on perinatal outcomes

Body mass index (BMI) and extremes of gestational weight gain (GWG) have been shown to negatively affect perinatal outcomes. IOM guidelines recommend GWG based on BMI, providing a basis for counseling on weight gain and potential pregnancy complications. The COVID-19 pandemic has created unique conditions predisposing women to extremes of GWG by limiting ability to exercise and access adequate nutrition, compounded by financial strain. The objective of the current study was to evaluate the effect of GWG based on BMI category on multiple perinatal outcomes. This is a retrospective analysis of a prospective population-based cohort from a single institution. We utilized a 2-hospital, single academic institution database from August 2011 through July 2019 to collect maternal characteristics and obstetric outcomes. Analyses limited to pregnancy with documented 1st trimester visit. Groups were evaluated based on BMI category according to IOM guidelines for GWG. Outcomes adjusted for tobacco use, ethnicity, delivery route, maternal education, and hypertension. Adjusted OR estimated by logistic regression, with adjusted mean by general linear models. 42,419 pregnancies were evaluated with 22,155 gravidae included for analysis. Significantly increased BW and Cesarean delivery rate was observed among gravidae too much GWG (Table 1). Conversely, too little GWG was associated with a significantly earlier GA at delivery and 5-minute Apgar scores <7 (Table 1). Importantly, multivariate analysis of factors associated with too little GWG demonstrated a higher occurrence among GDM, with an adjusted OR of 6.08 for stillbirth and significantly increased risk of poor predictors of neonatal outcomes (Table 2). Untoward perinatal outcomes are associated with extremes of BMI and GWG. Much emphasis has focused on excess weight gain and obesity, but women with inadequate weight gain are also at increased risk for poor obstetric outcomes. Increased provider attention to risks of extremes of GWG is particularly important during the COVID-19 pandemic.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Psychosocial Stressors in Relation to Maternal Plasma Levels of Corticotrophin Releasing Hormone (CRH) During Pregnancy

Background: Psychosocial stress during pregnancy has been associated with a number of adverse birth outcomes, including preterm birth. However, we have a limited understanding of the biologic pathways that might link stress to adverse outcomes. Corticotrophin Releasing Hormone (CRH) may represent one possible mechanism, as elevated levels of CRH have been associated with preterm birth. The purpose of this study was to examine the relationships between maternal self-reported psychosocial stress and CRH during pregnancy. We hypothesized that women who experienced psychosocial stress would have elevated levels of CRH. Methods: Women were enrolled in the Chemicals in Our Bodies-2 cohort (N=496), a demographically diverse cohort of pregnant women in San Francisco. CRH (pg/mL) was measured in plasma obtained at the 2nd trimester visit. Psychosocial stress was assessed via self-reported questionnaire at the 2nd trimester and included dichotomous measures of neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, unplanned pregnancy, perceived stress, depression, and perceived community status. Linear regression was used to examine associations between psychosocial stressors and CRH. Results: Experiencing &gt;2 stressful life events was associated with elevated levels of CRH after adjusting for gestational age at visit, maternal race/ethnicity, maternal education, and marital status (β=0.16, 95% confidence interval [CI]=0.02, 0.31). Women who experienced financial strain (β=0.13, 95% CI=-0.10, 0.36), caregiving for an ill family member (β=0.13, 95% CI=-0.06, 0.32), or who had elevated levels of perceived stress (β=0.20, 95% CI=-0.20, 0.41) also had moderately increased CRH levels. No associations were observed between other psychosocial stressor and CRH levels. Conclusions: We observed a positive association between stressful life events and elevated CRH levels in our study population. Future research should explore the combined effects of psychosocial stress and chemicals on birth outcomes and examine CRH as a mediator of the psychosocial stress and birth outcomes relationships.

Impact of Dietary Habit, Iodine Supplementation and Smoking Habit on Urinary Iodine Concentration During Pregnancy in a Catalonia Population

(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009–2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 μg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC ≥ 150 μg/L and the women’s dietary habits showed that the percentage with UIC ≥ 150 μg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.

Profile of Reported Alcohol, Tobacco, and Recreational Drug Use in Nulliparous Women.

To estimate alcohol, tobacco, and recreational drug use during pregnancy among nulliparous women. In a cohort of nulliparous women followed through pregnancy from the first-trimester nuMoM2b (Nulliparous Outcomes in Pregnancy: Monitoring Mothers to be) study, self-reported use of alcohol, tobacco, and drugs was chronicled longitudinally at four study visits in this secondary analysis. Rates of use before pregnancy, in each trimester (visit 1, visit 2, visit 3, approximating each trimester), and at the time of delivery (visit 4) were recorded. The amount of alcohol, tobacco, and drug exposure were recorded using validated measures, and trends across pregnancy were analyzed. Of the 10,038 study participants, 10,028 had information regarding alcohol, tobacco, and drug use at visit 1, 9,412 at visit 2, 9,217 at visit 3, and 7,167 at visit 4. The rates of drinking alcohol, which had been 64.6% in the 3 months before pregnancy, were lower in pregnancy (3.9% at visit 1, 5.6% at visit 2, 7.0% at visit 3, and 6.1% at visit 4, P<.001 for all). Rates later in pregnancy were all greater than in the first trimester (P<.01). The rate of smoking in the 3 months before pregnancy, which was 17.8%, also declined at visit 1 (5.9%), and continued to decline through pregnancy (5.3% at visit 2, 4.7% at visit 3, and 3.9% at visit 4, with all rates lower than that of visit 1 [P<.01]). Although recreational drug use was relatively common in the months before pregnancy (33.8%), it also declined during pregnancy (1.1% at visit 2, 0.7% at visit 3, 0.4% at visit 4). In this geographically and ethnically diverse cohort of nulliparous women, rates of self-reported alcohol, smoking, and recreational drug use were all significantly lower during than before pregnancy. Nonetheless, rates of alcohol use rose as pregnancy progressed, highlighting the need for continued counseling throughout all trimesters of pregnancy. ClinicalTrials.gov, NCT01322529.