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Session 6A BMFMS: Pregnancy Outcome

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6.1 THE RELATION BETWEEN SOCIAL DEPRIVATION AND STILLBIRTH CAUSES

A. Tang, M. Whitworth, D. Roberts. Liverpool Women’s NHS Foundation Trust, Liverpool, UK

Social deprivation is an important determinant of poor health. We aimed to identify appropriate health targets by investigating associations between social deprivation and causes of stillbirth in Liverpool Women’s NHS Foundation Trust.

Methods: All stillbirths occurring between 2004 and 2006 were included in the study and classified with ReCoDe. Maternal postcode was used to determine the index of multiple deprivation (IMD) for each patient. Women in IMD decile 1 (poorest 10% of England) were compared with women in IMD deciles 3–9. Results were analyzed using RevMan v4.2 (see table).

Results: 55% of our antenatal population are from IMD 1. We investigated 152 stillbirths. The numbers of observed and expected stillbirths in each IMD decile are similar. 46% of women from IMD 1 are smokers compared with only 7% in the least deprived group. There is a significant difference in the specific causes of stillbirths.

Conclusions: Current antenatal management is preventing an excess of stillbirths in the most deprived women. However, to make an impact in decreasing stillbirth rates in the next decade, we need to increase the awareness of fetal growth restriction in the community and to identify methods to diagnose which fetal growth restriction babies are at risk of stillbirth.

6.2 ADVERSE PERINATAL OUTCOMES AND RISK FACTORS FOR PRE-ECLAMPSIA IN WOMEN WITH CHRONIC HYPERTENSION: A PROSPECTIVE STUDY

L. C. Chappell, S. Enye, P. Seed, A. L. Briley, L. Poston, A. H. Shennan. King’s College, London, UK

Objective: Prospective contemporaneous data on pregnancies in chronic hypertensive women are sparse; the purpose of this study was to characterise pregnancy outcome and risk factors for superimposed pre-eclampsia.

Methods: Indices of maternal and perinatal morbidity and mortality were ascertained in 822 women with chronic hypertension with data prospectively collected and rigorously validated.

Results: The incidence of superimposed pre-eclampsia was 22% (n  =  180) with early-onset pre-eclampsia (⩽34 weeks’ gestation) accounting for nearly half. Delivering an infant <10th customised birthweight centile complicated 48% (87/180) of those with superimposed pre-eclampsia and 21% (137/642) of those without (relative risk (RR) 2.30; 95% CI 1.85 to 2.84). Delivery at <37 weeks’ gestation occurred in 51% of those with superimposed pre-eclampsia and 15% without (RR 3.52; 95% CI 2.79 to 4.45). Using multiple logistic regression, black ethnic origin, raised body mass index, current smoking, booking systolic blood pressure of 130–139 mm Hg and diastolic blood pressure of 80–89 mm Hg, a previous history of pre-eclampsia and chronic renal disease were identified as risk factors for pre-eclampsia.

Conclusions: In the largest study of its kind in chronic hyper<1?show=[fo]?>tensive women, these data demonstrate that the prevalence of infants born small for gestational age and preterm is considerably higher than background rates and is increased further in women with pre-eclampsia. These rates are higher than those previously reported, suggesting that the use of customised birthweight centiles provides a more accurate determination of fetal growth restriction. Smoking is an independent risk factor for superimposed pre-eclampsia, in contrast to the protective effect in low-risk pregnant women.

6.3 TEENAGE PREGNANCY AND MICRONUTRIENT STATUS: A STUDY OF 500 PREGNANT TEENAGERS FROM TWO UK INNER CITY POPULATIONS (THE ATE STUDY)

L. Poston1, S. Wheeler1, T. Sanders1, A. Briley1, P. Seed1, J. Thomas1, C. Hutchinson1, K. Clark2, P. Baker2. 1King’s College, London, UK, 2Manchester University, Manchester, UK

Aims: Pregnancy outcome was assessed prospectively in a cohort of UK pregnant teenagers and associations with nutritional status investigated. 500 pregnant teenagers were recruited from two inner-city populations in the United Kingdom.

Methods: Nutritional status was assessed by dietary 24-h recall interviews and measurement of relevant indices in blood samples obtained in the third trimester. Associations with pregnancy outcome were explored using univariate and multiple regression analysis.

Results: 17.6% of babies were born small-for-gestational age (SGA) as assessed by customised birthweight centiles (<10th centile). 9.0% of infants were born preterm. Maternal iron deficiency anaemia in late pregnancy was highly prevalent (52.1%) and 30.4% of participants had 25-hydroxyvitamin D concentrations <25 nmol/l indicating vitamin D insufficiency. Univariate logistic regression identified several predictors of SGA birth, including low folate status (red cell folate, p = 0.003; serum folate, p = 0.016; serum total homocysteine, p = 0.025) as well as folate dietary intake and raised serum ferritin. Maternal smoking, higher maternal age, low BMI, low gestational weight gain, high BMI at booking were also predictive of SGA birth. Serum total homocysteine was a predictor of preterm birth.

Conclusions: This study suggests that dietary factors may play an important role in poor pregnancy outcome in teenagers from inner-city UK populations. Dietary interventions that increase folate and vitamin D intake in pregnant teenagers should be evaluated in prospective studies.

6.4 MATERNAL OBESITY AND THE RISK OF STILLBIRTH IN SMALL-FOR-GESTATIONAL AGE BABIES IDENTIFIED BY CUSTOMISED BIRTHWEIGHT CENTILES

J. Gardosi, B. Clausson, A. Francis. Perinatal Institute, Birmingham, UK

Background: Maternal obesity is a risk factor for adverse pregnancy outcome. It is also considered to “protect” against the delivery of a small-for-gestational age (SGA) baby.1 We wanted to examine this claim by using a customised weight standard.

Methods: The cohort consisted of a comprehensive database of 326 377 routine ultrasound-dated Swedish pregnancies. SGA was defined by two methods: (1) 10th centile based on the Swedish population standard (SGApop); (2) 10th centile customised for maternal height, weight, parity, ethnic origin and baby’s sex. Maternal obesity was defined as BMI ⩾30. Outcome was assessed by rates of stillbirth.

Results: 22 083 mothers had a BMI ⩾30 (6.8%) and this group had a significantly elevated risk of stillbirth compared with the non-obese population (odds ratio (OR) 1.99, CI 1.62 to 2.43). This risk was still elevated when babies that were SGA by either method were excluded (OR 1.48, CI 1.16 to 1.88). Being small by both methods (SGApop and SGAcust) resulted in a higher risk of stillbirth (n  =  1342; OR 6.06, CI 3.87 to 9.48). However, a similar number of cases was additionally identified by SGAcust and these also had an elevated risk of stillbirth: n  =  1332; OR 5.49, CI 3.43 to 8.78.

Conclusions: Maternal obesity represents an increased risk factor for stillbirth, which is much higher when the fetus is SGA. Obesity does not “protect” against SGA, but in fact hides a substantial proportion of babies that can be identified as SGA by a customised standard. These previously unrecognised SGA babies of obese mothers have a high risk of intrauterine death.

6.5 MATERNAL AND OBSTETRIC ASSOCIATES OF BEING IN GOOD CONDITION FOLLOWING SINGLETON EXTREMELY PRETERM BIRTH

Z. Alfirevic1, E. M. Hennessy2, J. Myles2, E. S. Draper3, K. Costeloe2. 1University of Liverpool, Liverpool, UK, 2Barts and the London School of Medicine and Dentistry, London, UK, 3University of Leicester, Leicester, UK

Background: A heart rate >100 bpm 5 minutes after birth (HR >100/5 min) is independently associated with survival to discharge for extremely preterm livebirths in the national datasets collected for the EPICure studies in both 1995 and 2006.

Objective: To identify predictors of favourable neonatal outcome (HR >100/5 min) following extremely preterm birth.

Methods: An extensive dataset of maternal demographic, obstetric and neonatal factors was collected for all births 22 + 0 to 26 + 6 weeks in all English hospitals in 2006. Gestational age was validated using a hierarchical classification of scan dates, certain last menstrual period and working gestation.

Results: Data were collected for 1590 singleton births either born by Caesarean section or alive at the onset of labour of whom 1049 (66%) were liveborn with HR >100/5 (see table).

Abstract 6.5 Statistically significant associations from the logistic regression analysis for the outcome livebirth with HR >100/5 min

Conclusions: The only intervention highly associated with a favourable outcome for extremely preterm babies is the administration of antenatal steroids. Babies with placental abruption were much less likely to have HR >100/5 min. The incorporation of this information into clinical decision making remains a challenge for both obstetricians and neonatalogists.

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