Poster Session II Hypertension, Diabetes, Prematurity, Physiology www.AJOG.org

CONCLUSION: Portal hypertension in pregnancy confers an increasedrisk of preterm delivery, cesarean section, low birth weight, SGA, andneonatal death. Esophageal varices had a higher risk of low birthweight. These risks can be used to counsel patients with theseconditions.

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Outcomes from chronic hypertension in pregnancy bygestational age: a retrospective cohort studyTeresa Worstell1, Margaret Gorman1, Aaron Caughey11Oregon Health & Science University, Obstetrics & Gynecology, Portland, OR

OBJECTIVE: Chronic hypertension is a common comorbidity duringpregnancy, with estimated prevalence of 5%. It has been associatedwith worse maternal and neonatal outcomes. We aim to evaluatematernal and neonatal outcomes by gestational age in a large cohortof pregnant women with chronic hypertension.STUDY DESIGN: We conducted a retrospective cohort of pregnanciesassociated with a diagnosis of chronic hypertension in Californiabetween the years 2005-2008. We evaluated multiple outcomes,including cesarean rate, chorioamnionitis, post-partum hemorrhage,and birthweight <2500g or >4000. Results were stratified bygestational age at term. Statistical analysis was performed by chisquared test.RESULTS: Among 15,888 women with a diagnosis of chronic hy-pertension in pregnancy, cesarean rate, small for gestational age,macrosomia and chorioamnionitis all had a statistically significantrelationship to gestational age at delivery. Cesarean and small forgestational age had u-shaped distribution and were lowest at 40weeks with rates of 42.04% and 2.95%, respectively (p<0.001). Ratesof chorioamnionitis increased with gestational age, as did macro-somia. Post-partum hemorrhage was not found to be related togestational age.CONCLUSION: In this large retrospective cohort, an increase in ce-sarean and small for gestational age were observed at early and lateterm. Rates of chorioamnionitis and macrosomia were lower at earlyterm, and increased throughout additional weeks gestation.Although chronic hypertension is associated with post-partumhemorrhage, we did not find a correlation between hemorrhage andgestational age at delivery in this cohort.

S192 American Journal of Obstetrics & Gynecology Supplement to JANUARY

380 Optimal delivery timing for mild gestational

hypertension: a decision analysisAmanda Yeaton-Massey1, Mika Ohno1, Aaron Caughey21Stanford University School of Medicine, Department of Obstetrics &Gynecology, Stanford, CA, 2Oregon Health & Science University, Departmentof Obstetrics & Gynecology, Portland, OR

OBJECTIVE: Scarce data exist to direct the clinician to induction oflabor (IOL) or expectant management for pregnancies complicatedby mild gestational hypertension at term. The goal of this decisionanalysis is to assess optimal delivery timing to minimize maternaland neonatal morbidity and mortality.STUDY DESIGN:We created a decision-analytic model to compare IOLversus expectant management at 36, 37, 38 and 39 weeks gestationfor singleton pregnancies complicated by mild gestational hyper-tension. All costs and benefits were derived from the literature.Utilities were applied to life expectancies at a discount rate of 3% togenerate QALYs. At each gestational age a patient could 1) have anIUFD 2) spontaneously deliver 3) be induced or 4) proceed to thenext week of gestation up to 39 weeks of gestation. Maternal out-comes included developing severe preeclampsia and death. Neonataloutcomes included fetal demise, neonatal demise, and developingcerebral palsy (CP).RESULTS: Delivery at 36 weeks was associated with the highest rate ofCP with 2879 per million. Rates of CP decreased with every addi-tional week of gestational age attained. IOL at 38 weeks maximizedQALYs at 25.81 compared to IOL at 36 weeks (QALYs 24.51), IOL at37 weeks (QALYs 25.13) and IOL at 39 weeks (QALYs 25.10).CONCLUSION: For singleton gestations complicated by mild gesta-tional hypertension induction of labor at 38 weeks maximizes benefitand minimizes maternal and neonatal morbidity.

Outcomes by gestational age at delivery withgestational hypertension

*per 10,000; **per million.

381

Examining the starting dose of glyburide in gestationaldiabetesAngelica Glover1, Alan Tita1, Joseph Biggio1, Lorie Harper11University of Alabama at Birmingham, Obstetrics and Gynecology,Birmingham, AL

OBJECTIVE: Glyburide is commonly used in the management ofgestational diabetes (GDM). Rapid elimination of glyburide duringpregnancy suggests that higher doses may be needed. Therefore, weexamined the impact of initial glyburide dose on perinatal outcomes.

2014

www.AJOG.org Hypertension, Diabetes, Prematurity, Physiology Poster Session II

STUDY DESIGN: Retrospective cohort of all singleton pregnanciescomplicated by GDM from 2007-2012. Subjects were excluded ifthey had major maternal medical illness, fetal anomalies, or they didnot receive glyburide. Women were classified by initial glyburidedose: 2.5mg daily (2.5QD) versus 5mg daily (5QD). Outcomesincluded time to blood glucose control (<50% of blood sugars abovefasting and post-prandial goals), preeclampsia, cesarean delivery, andmaternal hypoglycemic events (<60 mg/dL). Neonatal outcomesconsidered were birth weight, macrosomia (>4000g), hypoglycemia(<40 mg/dL), shoulder dystocia, and a composite of stillbirth,neonatal death, cord arterial pH<7.0 or base excess <-12, and birthinjury. Groups were compared using student’s t-test or chi-squaredtest, as appropriate. Logistic regression was used to refine point es-timates while adjusting for obesity.RESULTS: Of 278 subjects, 139 started on 2.5QD and 139 on 5QD.Women on 5QD were more likely to be obese (or could say hadhigher BMIs) than women started on 2.5QD. The increased dose didnot shorten time to blood glucose control nor increase maternalhypoglycemic events (Table). A nominal increase in macrosomia inthe 5QD group was not significant after adjusting for maternalobesity (AOR 1.56, 95% CI 0.80-3.05). There were no significantdifferences in the composite perinatal outcome or any neonataloutcomes including hypoglycemia and shoulder dystocia.CONCLUSION: A higher starting dose of glyburide for the managementof A2 GDM did not increase maternal or neonatal complicationshypoglycemia. However, there was a lack of improvement in peri-natal outcomes, a finding which may be at least partially due to anincreased prevalence of obesity in women on higher starting doses.

Associations between maternal and perinataloutcomes and starting dose of glyburide

Data are mean +/- standard deviation or n (%), unless otherwise specified.

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Impact of maternal pre-pregnancy body mass index andgestational weight gain on offspring IQNoelia Zork1, Karin Fuchs1, Sarah Brubaker1, Cara Pessel1,Cande Ananth11Columbia University, Obstetrics and Gynecology, New York, NY

OBJECTIVE: To compare 4-year IQ of normally grown term infantsborn to women with gestational weight gain under, at, and over therecommendations of the 2009 Institute of Medicine (IOM)guidelines.STUDY DESIGN: We used data from the US Collaborative PerinatalProject (1959-66), a multicenter, prospective cohort of almost 60,000pregnancies. Analysis was restricted to live-born term singletonswith birthweights 2500-4200g. Major congenital anomalies andneonatal morbidities, genetic syndromes, newborn endocrine dis-orders, parental intellectual disability, maternal substance abuse, and

Supplem

maternal thyroid disorders were excluded. Using pre-pregnancybody mass index (BMI, kg/m2), subjects were grouped according tothe 2009 IOM classification of underweight (<18.5), normal weight(18.5-24.9), overweight (25-29.9), and obese (�30). Gestationalweight gain was categorized according to pre-pregnancy BMI andIOM guidelines: Under Goal, At Goal, and Over Goal. Within eachBMI group, offspring Stanford-Binet IQ at age 4 was comparedbetween weight gain groups using At Goal weight gain as thereference. Analyses were adjusted for smoking, breastfeeding, so-cioeconomic index, income, race and maternal education.RESULTS: Mean offspring IQ of normal weight women (98.9�16.4)was significantly higher than underweight (97.2�15.6), overweight(95.8�15), and obese (95.5�14.9) women (P<0.0001). In all BMIgroups, except underweight, there was a decrease in offspring IQwith inappropriate weight gain(Table 1). Adjusted analysis showed asignificant decrease in offspring IQ with Over Goal weight gain inthe normal and overweight groups, whereas Under Goal weight gainamong obese women resulted in a higher offspring IQ(Fig 1).Gestational weight gain still did not affect 4 year IQ among under-weight women.CONCLUSION: In this historical cohort, excessive gestational weightgain in normal, overweight, and obese women had an adverseimpact on offspring IQ at age 4. Further research with a contem-porary cohort is needed to validate these findings.

Mean offspring IQ at 4 years by maternal weightgain based on IOM 2009 guidelines

Normal weight and at goal weight gain used as reference.

ent to JANUARY 2014 American Journal of Obstetrics & Gynecology S193