Category Archives: 2016 Annual Meeting

SMFM Releases Statement on Ultrasound Screening for Fetal Microcephaly following Zika Virus Exposure

WASHINGTON (April 13, 2016)— The Society for Maternal-Fetal Medicine released a statement on the use of ultrasound screening for fetal microcephaly following Zika virus exposure.

Microcephaly is a condition in which the size of the head is smaller than expected for age. This condition in fetuses and infants has been associated with the recent outbreak of Zika virus.  Due to this association, the Centers for Disease Control and Prevention, American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have suggested ultrasound evaluation to measure the baby’s head in pregnant women who have been infected or potentially exposed.  Diagnosis of microcephaly by ultrasound is not always straightforward and can be complex. The Society for Maternal-Fetal Medicine provided recommendations on how to interpret the findings, including when to perform follow up ultrasound, as well as a table of values at each week of pregnancy that would define the lower limit of normal. The goal is to provide the tools to health care providers to counsel women who may have been exposed to the Zika virus. The Society for Maternal-Fetal will continue to assist clinicians in tackling this new health threat.

For more information on the Society of Maternal-Fetal Medicine’s recommendations and the Zika virus, go to www.smfm.org/education/zika or visit SMFM’s publications www.smfm.org/publications.

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Society for Maternal-Fetal Medicine Releases Statement on use of Antenatal Corticosteroids in the Late Preterm Birth Period in Women at Risk for Preterm Birth

WASHINGTON (April 6, 2016)— The Society for Maternal-Fetal Medicine released a statement on the use of antenatal corticosteroids during the late preterm birth period for women at risk of preterm birth. The statement, is currently available online and will be published in the July issue of the American Journal of Obstetrics and Gynecology. It comes on the heels of a study and a presentation at SMFM’s annual meeting in Atlanta in February where researchers with the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Maternal-Fetal Medicine Units Network (MFMU) presented findings that the administration of antenatal steroids in pregnancies at risk for late preterm delivery prevents respiratory and other neonatal complications.

The study, titled Antenatal Late Preterm Steroids (ALPS): a Randomized Trial to Reduce Neonatal Respiratory Morbidity was a randomized, double-blind, placebo-controlled trial at 17 tertiary medical centers around the United States from Oct. 2010 to Feb. 2015.  The study enrolled 2,831 women with singleton pregnancies at high risk for late preterm delivery (34 0/7 to 36 6/7 weeks) who were randomized to receive antenatal betamethasone intramuscularly or a matching placebo.  This study found a significant decrease in neonatal respiratory complications in the group given the steroid treatment.  Investigators also found that these babies were less likely to have prolonged intensive care nursery stays, less likely to need postnatal treatment for respiratory complications, and less likely to develop bronchopulmonary dysplasia, which is a sign of chronic lung disease. Prior to this report, such treatment was only recommended with risk of preterm delivery before 34 weeks of gestation, as infants in the late preterm period were thought to be at little, if any, increased risk of complications.

Lead investigator, Cynthia Gyamfi-Bannerman, M.D., MSc, the Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women’s Health (in Obstetrics and Gynecology) from Columbia University Medical Center, put the findings in context: “The majority of preterm deliveries occur in the late preterm period.  We now have a treatment that can significantly improve outcomes for these at risk babies.”  The study was co-funded by the NHLBI, with the aid of program officer Carol Blaisdell, M.D. and the NICHD under the guidance of Uma Reddy, M.D.

In their statement, the Society for Maternal-Fetal Medicine recommends:

  • In women with a singleton pregnancy between 34 weeks to 36 6/7 weeks of gestation who are at high risk for preterm birth within the next seven days (but before 37 weeks of gestation), SMFM recommends treatment with betamethasone, a corticosteroid demonstrated to decrease neonatal complications in preterm infants.
  • In women with preterm labor symptoms in the late preterm period, SMFM recommends waiting for evidence of true preterm labor, such as a cervical dilatation of at least three centimeters or effacement of at least 75% before treatment with betamethasone.
  • In women with late preterm pregnancies receiving betamethasone, SMFM recommends against the use of tocolysis in an attempt to delay delivery to complete the steroid course since it is unclear if the benefits are outweighed by the risks of attempts to delay delivery.
  • In women with late preterm pregnancies with a potential medical indication for delivery, SMFM recommends betamethasone not be given unless there is a definitive plan for late preterm delivery.
  • SMFM also recommends against the implementation of antenatal late preterm steroids protocol for conditions not studied in the randomized controlled trials.

Given that more than 300,000 pregnancies deliver in the late preterm period each year in the U.S., the study along with recommendations for adoption by the Society for Maternal-Fetal Medicine will have a significant impact on the health of newborns and infants.

For more information on SMFM publications, go to https://www.smfm.org/publications.

Study Shows Maternal Diet Alters the Breast Milk Microbiome and Microbial Gene Content

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 at 2:30 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Maternal Diet Alters the Breast Milk Microbiome and Microbial Gene Content.

Breast milk contains a diverse microbiome that is presumed to colonize the infant gastrointestinal tract and contribute to the establishment of the infant gut microbiome. The composition of the breast milk microbiome varies over time and among individuals, though the factors driving the variation are largely unknown. Since maternal diet during gestation and lactation has been previously shown to independently alter the offspring microbiome and offspring disease susceptibility, researchers speculated that the breast milk microbiome may be a mediator of this dietary impact. Two groups of lactating women participated in highly-controlled single-blinded cross-over dietary intervention studies to evaluate if maternal diet plays a significant role in structuring the taxonomic and metagenomic composition of the breast milk microbiome.

“We saw considerable differences based on maternal diet,” explained Kristen Meyer, with the Baylor College of Medicine, one of the researchers of the study and the presenter at the SMFM annual meeting. “Based on this, we speculate that the maternal diet serves as a significant driver of the early infant microbiome, reinforcing the gestational dietary impact,” added Meyer.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

 

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 

abstract 66

The Benefits of Chocolate During Pregnancy

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 4 at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, High-flavanol chocolate to improve placental function and to decrease the risk of preeclampsia: a double blind randomized clinical trial.

In light of previous studies showing conflicting results regarding the role of chocolate consumption during pregnancy and the risk of preeclampsia, this study set out to evaluate the impact of high-flavanol chocolate.  Researchers conducted a single-center randomized controlled trial of 129 women with singleton pregnancy between 11 and 14 weeks gestation who had double-notching on uterine artery Doppler.  The pregnant women selected were randomized to either high-flavanol or low-flavanol chocolate. A total of 30 grams of chocolate was consumed daily for 12 weeks and women were followed until delivery.  Uterine artery Doppler pulsatility index was at baseline and 12 weeks after randomization. Preeclampsia, gestational hypertension, placenta weight, and birthweight were also evaluated.

The result was that there was no difference in preeclampsia, gestational hypertension, placental weight or birthweight in the two groups; however, the uterine artery Doppler pulsatility index (a surrogate marker of blood velocity in the uterine, placental and fetal circulations) in both groups showed marked improvement that was much greater than expected in general population.

“This study indicates that chocolate could have a positive impact on placenta and fetal growth and development and that chocolate’s effects are not solely and directly due to flavanol content,” explained Emmanuel Bujold, M.D., one of the researchers on the study who will present the findings.  Dr. Bujold and Dr. Sylvie Dodin, principal investigator of the trial, are with the Université Laval Québec City, Canada.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 32    High-flavanol chocolate to improve placental function and to decrease the risk of preeclampsia: a double blind randomized clinical trial

Authors: Emmanuel Bujold1, Asma Babar1, Elise Lavoie1, Mario Girard2, Vicky Leblanc1, Simone Lemieux1, Lionel-Ange Poungui1, Isabelle Marc1, Belkacem Abdous1, Sylvie Dodin1

1Université Laval, Québec City, QC, Canada, 2Centre de recherche du CHU de Québec, Québec City, QC, Canada

Objective: Previous studies showed conflicting results regarding the role of chocolate consumption during pregnancy and the risk of preeclampsia. We aimed to evaluate the impact of high-flavanol chocolate in a randomized clinical trial.

Study Design: We conducted a single-center randomized controlled trial including women with singleton pregnancy between 11 and 14 weeks gestation who had double-notching on uterine artery Doppler. The pregnant women selected were randomized to either high-flavanol (HFC) or low-flavanol chocolate (LFC). A total of 30 g of chocolate was consumed daily for 12 weeks and women were followed until delivery. Uterine artery Doppler pulsatility index (UtA PI), reported as multiple of medians (MoM) adjusted for gestational age, was assessed at baseline and 12 weeks after randomization. Preeclampsia, gestational hypertension, placenta weight, and birthweight were also evaluated.

Results: One hundred twenty nine women were randomized at a mean gestational age of 12.4 ± 0.6 weeks with a mean UtA PI of 1.4 ± 0.4 MoM. Although adjusted UtA PI significantly decreased from baseline to 12 weeks in the 2 groups (<0.0001), the difference between the 2 groups was not significant (p=0.16). At 12 weeks, we observed no significant difference between HFC and LFC groups in the rate of preeclampsia (4.7% vs 3.1%, p=0.49) and gestational hypertension (6.2% vs 12.5%, p=0.56). Placental weight (466 vs 464 grams), p=0.93) and birthweight (3348 vs 3215 grams, p=0.07) were comparable between the two groups.

Conclusion: Compared with low-flavanol chocolate, daily intake of 30g of high-flavanol chocolate did not improve placental function, placental weight and the risk of preeclampsia. Nevertheless, the marked improvement of the pulsatility index observed in the 2 chocolate groups might suggest that chocolate effects are not solely and directly due to flavanol content.

Study Shows Impact of Sleep on Gestational Weight Gain During Pregnancy

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 4 at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Short and long sleep durations in pregnancy are associated with extremes of gestational weight gain.

Epidemiologic data from non-pregnant women has linked poor sleep with obesity and weight gain. The researchers in this study set out to determine the relationship between objectively measured sleep duration and weight gain during pregnancy.

Women studied were enrolled in the nuMoM2b study, a multi-center prospective cohort study of nulliparous women with a singleton gestation. They were recruited to wear an actigraph to record objective sleep activity for seven consecutive days. Women with pregestational diabetes and chronic hypertension were excluded from the study. Sleep duration was calculated as an average across study nights.  Actigraphy and weight gain data were reviewed for 751 women.  The majority of women (74.8%) had a sleep duration between seven and nine hours.

The data suggested that both short and long sleep duration in pregnancy are associated with gestational weight gain.  “We know that poor sleep in pregnancy has been linked to adverse pregnancy outcomes,” explained Francesca Facco, M.D., one of the researchers of the study who is with the Eunice Kennedy Shriver NICHD NuMoM2b Network in Bethesda, Md.  Dr. Facco will present the findings at the SMFM annual meeting. “Our findings provide a potential mechanism for poor sleep in pregnancy and adverse outcomes,” Facco added.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 33    Short and long sleep durations in pregnancy are associated with extremes of gestational weight gain

Authors: Francesca Facco1,2, Kathryn Reid3,1, William Grobman3,1, Corette Parker4,1, Shannon Hunter4,1, Matthew Koch4,1, Phyllis Zee3,1

1for the Eunice Kennedy Shriver NICHD NuMoM2b Network, Bethesda, MD, 2Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, 3Northwestern University, Chicago, IL, 4RTI International, Triangle Park, NC

Objective: Epidemiologic data from non-pregnant cohorts have linked poor sleep with obesity and weight gain. Our objective was to determine the relationship between objectively measured sleep duration and weight gain in pregnancy.

Study Design: Women enrolled in the nuMoM2b study, a multi-center prospective cohort study of nulliparous women with a singleton gestation, were recruited at the 2nd study visit (16- 21 weeks’) to wear an actigraph to record objective sleep activity for 7 consecutive days. Women with pregestational diabetes and chronic hypertension were excluded. Sleep duration (SD) was calculated as an average across study nights and categorized as follows: <6, 6 to <7, 7 to <8, 8 to <9, and >9 hours/night. Gestational weight gain (GWG) was calculated relative to self-reported prepregnancy weight using measured weights at visit 2 and visit 3 (22-29 weeks’), and chart abstracted last weight prior to delivery. We examined GWG using gestational age-standardized z-scores, a measure of GWG that by design is uncorrelated with gestational age at measurement and BMI. Z scores of <-1 and >+1 were used to define groups with the smallest and largest normalized weight gains, respectively.

Results: Actigraphy and weight data were available for 751 women. The majority of women (74.8%) had a SD between 7 to <9 hours; 2.1% and 5.2% had a SD of <6 and >9 hours/night, respectively. Non-linear relationships were observed between SD and GWG (see Table). For all GWG assessments, large GWG (Z>+1) became less frequent as SD increased. Women with the shortest (<6) and the longest (> 9) SD had the highest rates of small GWG ( Z<-1). Differences were statistically significant for GWG at Visit 2 and Visit 3 (p<.0001, p=.04) and were similar in magnitude for the last weight prior to delivery (p=0.0504).

Conclusion: Our data suggests that both short and long SD in pregnancy are associated with GWG. Poor sleep in pregnancy has been linked to adverse pregnancy outcomes, and our findings provide one potential mechanism for this association.

Abstract 33

Study Shows Increased Risk of Early Mortality in Women with Hypertensive Disease During Pregnancy

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 at 8 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Long-term mortality risk following hypertensive disease of pregnancy (HDP).

It has long been recognized that pregnancy puts considerable stress on the body and that there are specific conditions during pregnancy that will indicate lifelong health issues. The objective of this study was to assess whether women with a history of any hypertensive disease during pregnancy have increased risk for early mortality and to determine the timing and most common cause of their deaths.

The study looked at births from 1939 to 2012 using the Utah Population Database. Based on birth certificate data, researchers assigned a diagnosis of HDP and, when possible, the category of disease (gestational hypertension, preeclampsia, HELLP syndrome—a serious complication of high blood pressure during pregnancy, and eclampsia).  Exposed women had a singleton pregnancy complicated by HDP and lived in Utah for more than a year following delivery. Primary cause of death was ascertained from death certificates.

Of 2,083,331 birth certificates evaluated, 61,727 (3%) had HDP.  Of these, all-cause mortality was significantly increased for women with a history of HDP. They also had the greatest risk of mortality due to Alzheimer’s disease, diabetes, ischemic heart disease, and stroke.

“We now know that women with a history of any category of HDP are at increased risk for mortality from a variety of causes,” stated Lauren Theilen, M.D. one of the researchers on the study who will present the findings at the SMFM annual meeting. Dr. Theilen is with the University of Utah Health Sciences Center in Salt Lake City.  “It’s important for physicians who care for these women beyond their childbearing years to recognize the significance of a history of HDP so that these women may receive appropriate screening and intervention,” Theilen added.

The study concluded that women with a history of HDP have increased risk of early mortality with the highest hazard ratios for neurologic, endocrine and circulatory causes.  Increased mortality risk for these women begins approximately 20 years after pregnancy.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 45    Long-term mortality risk following hypertensive disease of pregnancy (HDP)

Authors: Lauren Theilen1,2, Alison Fraser3, Michael Hollingshaus4, Karen Schliep1, Michael Varner1,2, Ken Smith3, Sean Esplin1,2

1University of Utah Health Sciences Center, Salt Lake City, UT, 2Intermountain Healthcare, Salt Lake City, UT, 3Huntsman Cancer Institute, Salt Lake City, UT, 4University of Utah, Salt Lake City, UT

Objective: To assess whether women with a history of HDP have increased risk for early mortality, and to determine the timing and most common causes of their deaths.

Study Design: We defined a cohort of births from 1939-2012 using the Utah Population Database. Based on birth certificate data, we assigned a diagnosis of HDP and, when possible, the category of disease [gestational hypertension (GHTN), preeclampsia (PRE), HELLP syndrome, and eclampsia (ECL)]. Exposed women had a singleton pregnancy complicated by HDP and lived in Utah for ≥1 year after delivery. Women with >1 pregnancy with HDP were included only once, in the most severe group. Exposed women were matched (1:2) to women without HDP by age, year of childbirth, and parity at time of index pregnancy. Primary cause of death was ascertained from death certificates. Mortality risk by primary cause of death was compared between exposed women (stratified by category of disease) and unexposed women using Cox regression to adjust for infant sex, parental education, ethnicity, and marital status.

Results: Of 2,083,331 birth certificates evaluated, 61,727 (3.0%) unique women had HDP (GHTN 49,438, PRE 29,941, HELLP 921, ECL 1,137) in >1 pregnancy. These women were matched to 123,454 unexposed women. A total of 11,278 women had known death dates: 4,516 (7.3%) exposed and 6,762 (5.5%) unexposed. All-cause mortality was significantly increased among exposed women (HR 1.68, p<0.01) (Table 1). Exposed women had the greatest risk of mortality due to Alzheimer’s disease (HR 3.44, p<0.01), diabetes (HR 3.22, p<0.01), ischemic heart disease (HR 2.28, p<0.01), and stroke (HR 1.92, p<0.01). Hazard ratios for causes of mortality varied by category of HDP. Figure 1 illustrates the survival curve in years after the index pregnancy for women with each category of HDP.

Conclusion: Women with a history of HDP have increased risk of early mortality, with highest hazard ratios for neurologic, endocrine, and circulatory causes. Increased mortality risk begins 20 years after the exposed pregnancy.

Abstract 45-1 Abstract 45-2

Study on Use of Umbilical Cord vs. Biocellulose Film for Antenatal Spina Bifida Repair, Regenerative patch may improve neurological outcomes

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 in an oral plenary session at 8 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Cryopreserved Human Umbilical Cord (HUC) vs. Biocellulose Film (BCF) for Antenatal Spina Bifida Repair.

Spina Bifida is a birth defect where there is incomplete closing of the backbone and the coverings around the spinal cord. The birth defect is associated with lifelong disability and death due to complications. In-utero surgery has been recently shown to improve the ability to walk and to reduce the need for shunting of hydrocephalus. However, over half of these children do not benefit from the in-utero repair. Researchers are trying to find a regenerative patch material for repair that would further reduce morbidity after repair through decreased damage to the spinal cord from inflammation and scar formation. This study sought to compare two patches that can be used in utero to repair the closing of the backbone with material that will promote regeneration of different coverings of spine.

Although the study took place in a rat model of spina bifida, it provided promising results. The human umbilical cord patch was determined to promote cellular migration of epidermal, neuronal and endothelial cells with minimal inflammatory response compared to biocellulose film.

“By finding a patch that will regenerate coverings of the spinal cord, with minimal inflammation and scar formation, we hope to improve the outcomes of in-utero spina bifida repair. We have established more evidence in large animal models and human cases, which showed similar results. This is a initial step toward a safe minimally invasive in-utero repair.” stated Ramesha Papanna, M.D., M.P.H., the principal investigator of the project at The Fetal Center, Children’s Memorial Hermann Hospital Dept. OB/GYN McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).  Saul Snowise, M.D. is a fetal intervention fellow at The Fetal Center and has actively worked and participated under the guidance of his mentor Dr. Papanna in the development of this project.  Dr. Snowise is the primary author of the study and will present the findings.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 Abstract 47:   Cryopreserved Human Umbilical Cord (HUC) vs. Biocellulose Film (BCF) for Antenatal Spina Bifida Repair

Authors: Saul Snowise1, Lovepreet Mann1, Mi-Ae Lyu1, Yisel Morales1, Kenneth J. Moise Jr.1, Stephen Fletcher1, Ray Grill2, Schaeffer CG Tseng3, Anthony Johnson1, Ramesha Papanna1

1The Fetal Center, Children’s Memorial Hermann Hospital Dept. OB/GYN UT Health- University of Texas Medical School at Houston, Houston, TX, 2Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, 3Ocular Surface Center, Miami, FL

Objective: Antenatal fetoscopic spina bifida (SB) repair with a regenerative patch may improve neurological outcomes by allowing earlier intervention and decreasing inflammatory scarring. Our objective was to compare two patches, HUC and BCF sutured over SB lesions in a retinoic acid (RA) rat model, for regenerative ingrowth of native cells and associated inflammatory response.

Study Design: Pregnant time-dated Sprague-Dawley rats were gavaged with RA (40mg/kg) on gestational day 10 (GD10) to induce SB in pups. Laparotomy and hysterotomy were performed on GD20 and HUC (n=11) or BCF (n=10) sutured over the spinal defect. Patches placed into the amniotic cavity without suturing over the lesion were controls. 30-34 hours after grafting pups were harvested and formalin fixed. H&E and Trichrome staining assessed cellular migration into the patches. Immunohistochemistry was performed to demonstrate the nature of the cellular migration. Native cell markers evaluated were CK 5/6 (epidermal), GFAP (astrocytes) and vWF (endothelial). Inflammatory markers were CD3 (lymphocytes), MPO (neutrophils), and F4-80 (macrophages). Four high power fields (hpf) of all patches and surrounding exudates were evaluated and Image-J software was used to quantify cells.

Results: Pup survival was equal: HUC 8/11, BCF 7/10, (p=0.9). Histology showed cellular migration in all HUC patches applied over lesions (median:38[range;13-102] cells/hpf) compared to none in BCF patches (Figure; p<0.001). CK 5/6 positive cells were noted migrating over the HUC patch surface (4-7cells/hpf): GFAP positive cells were noted on the HUC patch surface adjacent to the lesion (3-11 cells/hpf); vWF positive cells were noted in the HUC patch (5-15cells/hpf). No CK 5/6, GFAP or vWF positive cells were noted in BCF patches (p=0.03). HUC patches showed minimal MPO (2%[0-7%]), CD3 (7%[3-12%]) and F4-80 (0%) positive cells. Exudates in HUC treated pups had fewer MPO (0%[0-9%] vs 17%[0-39%]; p<0.01) and CD3 (7%[0-13%] vs 15%[0-22%]; p<0.01) positive cells compared to BCF and demonstrated no difference in F4-80. Both HUC and BCF control patches demonstrated no infiltrate.

Conclusion: HUC promotes cellular migration of epidermal, neuronal and endothelial cells with minimal inflammatory response compared to BCF. HUC may be the ideal patch material for use in antenatal SB repair.

Effectiveness of Influenza Vaccine for Pregnant Women May Differ by Trimester

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 in an oral concurrent session at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, T-follicular helper (Thf) cell expansion varies by trimester after influenza vaccination in pregnancy.

The Centers for Disease Control recommends that all pregnant women get a flu shot, unless they have already been vaccinated over the past year.  Cautioning that “Flu is more likely to cause severe illness in pregnant women than in healthy women who are not pregnant,” the CDC website recommends that pregnant women may safely get the shot during any trimester.

In the study to be presented, researchers found that the T-follicular helper cell response to vaccination is greatest during the first trimester of pregnancy.  Vaccine immunology is poorly understood in pregnancy and Tfh cell expansion has been shown to be a predictor of response to influenza vaccination outside of pregnancy.

The researchers studied 36 pregnant women during flu season in 2012 to 2014.  They administered inactivated influenza vaccine and blood samples were collected pre-vaccination and 14 days later.  The influenza specific T-follicular helper cell response varied based on trimester of pregnancy in which the vaccine was given.

“The study results suggest that immunological changes during pregnancy may affect the response to the vaccination,” stated Emily Patel, M.D. with Duke University.  Dr. Patel is one of the researchers and the presenter of the study. “Future studies will lead to a better understanding of vaccine immunology and how pregnant women respond to antigen exposure through the course of their pregnancy,” added Patel.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 80:   T-follicular helper (Tfh) cell expansion varies by trimester after influenza vaccination in pregnancy

Authors: Emily Patel1, Chad Grotegut1, R. Phillips Heine1, Janet Staats1, Brian Antczak1, Kristin Weaver1, Kent Weinhold1, Geeta Swamy1

1Duke University, Durham, NC

Objective: Vaccine immunology is poorly understood in pregnancy. Tfh cell expansion has been shown to be a predictor of response to influenza vaccination outside of pregnancy. Our objective was to determine if Tfh cell expansion after vaccination changes based on trimester of pregnancy.

Study Design: Inactivated Influenza Vaccine (IIV) was administered during the 2012-2014 influenza seasons to 36 pregnant women. Blood samples were collected pre-vaccination and 14 days later. Peripheral blood mononuclear cells (PBMC) were isolated at each time point. Frequency and phenotype of influenza specific T-follicular helper cells (CD4+, CXCR5+, IL21+) was measured using polychromatic flow cytometry. Frequencies were compared using Wilcoxon signed rank test.

Results: The influenza specific T-follicular helper cell response varied based on trimester of pregnancy in which the vaccine was given. There was a significant expansion of Tfh cells after vaccination among women in the first trimester (p=0.036) but there was not a significant expansion after vaccination in either the second or third trimesters (p=0.091 and 0.347 respectively).

Conclusion: The Tfh cell response to vaccination is greatest during the first trimester of pregnancy. These results suggest that immunologic changes that occur during pregnancy may affect response to vaccination. Future work in this area will lead to a better understanding of vaccine immunology and how pregnant women respond to antigen exposure through the course of pregnancy.

Abstract 80

Study Shows Time of Hospital Rounds for Postpartum Women Impacts Patient Satisfaction

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 6 at 8:45 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Routine versus delayed timing of morning hospital rounds for postpartum women on patient satisfaction: A randomized quality improvement trial.

While it is convenient for physicians to have early morning hospital rounds so that they can handle other clinical duties including seeing patients in-office, it is not always convenient for postpartum hospital patients who often face sleep disruption and inadequate communication.

The study looked at 152 women with similar maternal demographics and clinical characteristics, except that delivery mode differed. More women had cesarean delivery in the routine.  The women were all under the care of a university-based obstetrics/gynecology faculty practice and delivered at a tertiary care medical center. They were randomly allocated to either routine rounding (4-7 a.m.) or delayed physician rounding (after 8 a.m.) from postpartum day one until discharge. Women with medical conditions or delivery complications that precluded the ability to delay rounding were excluded. On day of discharge, research staff blinded to rounding group distributed a standardized survey that included questions regarding physician communication and hospital experience.

The result was that postpartum women who received delayed physician rounding were more satisfied with physician communication and overall hospital experience without prolonging their hospital stay or time of discharge.

“This simple study indicates that physicians should be more cognizant of the hours they perform their rounds with healthy postpartum patients,” stated Robyn P. Roberts, M.D.  Roberts, with the University of Texas Medical School at Houston was researcher on the study and will present the study this week at the SMFM annual meeting.  “By just moving rounds later in the morning, patient satisfaction can be significantly improved,” added Roberts.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 84:   Routine versus delayed timing of morning hospital rounds for postpartum women on patient satisfaction: A randomized quality improvement trial

Authors: Robyn P. Roberts1, Sean C. Blackwell1, Kelly M. Brown1, Baha M. Sibai1, Jon E. Tyson1

1UT Health-University of Texas Medical School at Houston, Houston, TX

Objective: Early morning physician rounding is a part of traditional hospital culture. Benefits include early patient discharge as well as physician convenience to begin other clinical duties. Potential disadvantages include inadequate communication and sleep disruption. The objective of this study was to determine whether timing of physician rounding of postpartum women impacts patient satisfaction.

Study Design: Women under the care of a university-based OB/GYN faculty practice who delivered at a tertiary care medical center were randomly allocated to either routine rounding (4 – 7am) or delayed physician rounding (after 8 am) from postpartum day 1 until discharge. Women with medical conditions or delivery complications that precluded the ability to delay rounding were excluded. On day of discharge, research staff blinded to rounding group distributed a standardized survey that included questions regarding physician communication and hospital experience. Based on delivery volumes, we planned to conduct the study over a pre-defined two month period. We estimated that the study would require 74 total subjects (N=37 per group) to detect a 20% difference in overall rating of the hospital (0-10 score) between groups (assumption P=0.05 and power 90%).

Results: 152 women participated in the study (N= 76 routine rounding; N= 76 delayed rounding). Maternal demographics and clinical characteristics were similar between groups except for delivery mode. More women had cesarean delivery in the routine compared to delayed rounding group (47.4% vs. 22.4%). Patient satisfaction scores were improved not only for quality of physician communication, but also for hospital experience and overall hospital rating (see Table). Adjustment for delivery mode with linear regression did not alter the findings (p < 0.001). There were no differences between groups in timing of maternal discharge occurring after 10 am (25% routine vs. 30.3% delayed; p=0.47) or timing of neonatal discharge after 10 am, 94.7% vs. 90.8% (p=0.35).

Conclusion: Postpartum women who received delayed physician rounding were more satisfied with physician communication and overall hospital experience without prolonging their hospital stay or time of discharge.

 Abstract 84

Study Develops New Equation for Estimating Gestational Age

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 6 at 8:45 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, The NICHD Fetal Growth Studies: Development of a contemporary formula for estimating gestational age from ultrasound fetal biometrics.

Accurate assessment of gestational age is an important variable affecting perinatal morbidity and mortality. The most commonly used formula for estimating gestational age has been Hadlock’s formula which uses biparietal diameter, head circumference, femur length and abdominal circumference. If gestational age is not accurately estimated, induction of labor may be performed inappropriately. A smaller premature fetus may be thought to have fetal growth restriction and undergo induction of labor, which can produce prematurity. A fetus wrongly thought to be post term may also undergo induction of labor, which is an unnecessary intervention. It is important to accurately estimate gestational age.

Researchers used fetal biometric data from the National Institute of Child Health and Human Development Fetal Growth Studies. They sought to develop and validate a new gestational age estimation equation and compare its accuracy to Hadlock formula created in 1984.

Healthy women from four racial/ethnic groups comprised of 614 (26%) non-Hispanic whites, 611 (26%) non-Hispanic blacks, 649 (28%) Hispanics and 460 (20%) Asians. All were low-risk for altered fetal growth and reported a sure last menstrual period, underwent serial ultrasound every four weeks starting at an average of 19.7 weeks.

Biparietal diameter (BPD) which is one of the basic biometric parameters to assess fetal size, abdominal circumference (AC), femur length (FL) and head circumference (HC) were used to develop a formula for estimating gestational age.  The formula was validated using 50% training and test set paradigm; a 50% random sample was used to develop the predictor and the remaining 50% was used to evaluate predictive accuracy. This procedure was run one thousand times and the predictive accuracy measures averaged. Comparative formula accuracies were assessed using the standard deviation of prediction derived from the predicted versus actual population gestational ages.

Daniel W. Skupski, M.D., one of the researchers of the study who is with New York Presbyterian Queens in Flushing, N.Y. and will present the findings said, “We have developed and validated a new equation for estimating gestational age from fetal biometrics measured between 14 and 22 weeks gestational age using a multi-racial/ethnic population, certified sonographers and modern ultrasound units.”  The study shows a slight improvement in this newly developed formula over the traditional Hadlock with accuracy of less than nine days versus less than 10 days for Hadlock.  It also validates the establishment of this new formula in a large, high-quality multi-center study.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 105  The NICHD Fetal Growth Studies: Development of a contemporary formula for estimating gestational age from ultrasound fetal biometrics

Authors: Daniel W. Skupski1, John Owen2, Sungduk Kim3, Paul Albert3, Katherine Laughon Grantz3

1New York Presbyterian Queens, Flushing, NY, 2University of Alabama at Birmingham, Birmingham, AL, 3Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD

Objective: Using fetal biometric data from the NICHD Fetal Growth Studies, we sought to develop and validate a new gestational age (GA) estimation equation and compare its accuracy to a commonly used formula (Hadlock 1984).

Study Design: Healthy women from 4 racial/ethnic groups who were low-risk for altered fetal growth and reported a sure LMP confirmed by CRL at <14+0 weeks, underwent serial ultrasound every 4 weeks, starting at an average of 19.7 weeks, using study-certified sonographers. Project EDC was based on the LMP date+280 days. Linear regression with BPD, AC, FL and HC and product terms were used to develop a formula for estimating GA. The formula was validated using 50% training and test set paradigm; a 50% random sample was used to develop the predictor and the remaining 50% was used to evaluate predictive accuracy. This procedure was run 1,000 times and the predictive accuracy measures averaged. Comparative formula accuracies were assessed using the standard deviation (SD) of prediction derived from the predicted versus actual population GA’s.

Results: The study population comprised: 614 (26%) non-Hispanic Whites, 611 (26%) non-Hispanic Blacks, 649 (28%) Hispanics, and 460 (20%) Asians. The best-fit formula was: GA=7.85-0.127*BPD+0.07304*HC+0.00638*AC+0.122*FL+0.000685*BPD*AC-0.00015*HC*AC; validation confirmed a SD of 4.57 days (2SDs=9.14 days). The SD of the Hadlock 1984 formula was 5.06 days (2 SDs=10.12 days). Figure 1 shows the observed versus the predicted GA for the best-fit formula.

Conclusion: We have developed and validated a new equation for estimating GA from fetal biometrics measured between 14 and 22 weeks’ gestational age using a multi-racial/ethnic population, certified sonographers and modern ultrasound units. Sonography confirms the best GA with accuracy of ≤ 9 days. Our study shows a slight improvement in our newly developed formula over the traditional Hadlock formula (accuracy ≤ 10 days) and validates this established formula in a large high-quality multi-center study.

Abstract 105