322
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
often associated with compromise in the other circulations, although the assessment of maternal vascular function by conventional means is cumbersome and expensive. Objectives: We sought to assess maternal hemodynamic function with a noninvasive cardiographic monitor, and to correlate the findings to both uteroplacental and fetoplacental vascular resistance. Methods: We measured cardiac output and index (CO, CI), systemic vascular resistance (SVR), mean arterial pressure (MAP) and an index of contractility (ICON) with a novel electrical impedance cardiograph (Aesculon EIC System, Cardiotronic, USA) that provides a volume independent estimate of cyclical blood flow velocity. We enrolled high-risk subjects between 22 and 25 weeks who were referred for assessment of fetal growth and uterine artery Dopplers due to abnormalities of serum screening analytes or other risk factors for preeclampsia. Doppler measurements of blood flow in the uterine arteries (pulsatility index, PI) and umbilical artery (systolic: diastolic ratio, S/D) were obtained by ultrasound (Voluson E8, GE Healthcare, Inc.), along with the fetal weight percentile (FW%). Data were expressed as medians (+/ range), and analyzed with Spearman’s correlation coefficient, R. Statistical significance was set to p = 0.05. Results: Electrical impedance cardiography (EIC) data was collected from seventeen subjects. There were no measurement failures. The median gestational age was 24.3 weeks and the BMI was 26.4 (21–47). The median PI, S/D and FW% were 0.96 (0.47–2.1), 3.3 (2.6–7.1), and 53% (6–82%). EIC results and their relationship to uterine and umbilical Dopplers and fetal growth are shown in Table 1. There were no significant correlations between maternal systemic hemodynamic parameters and uterine artery PI. On the other hand, maternal cardiac function was strongly related to the umbilical artery S/D ratio, and SVR was uniquely related to the FW%.
EIC Hemodynamic
Median
Correlation with Dopplers
Parameter
(range)
and growth (Spearman R; *
CO
7.5 (4.0–
= p < 0.05)
Uterine
Umbilical
PI
S/D
FW%
0.29
0.72
*
0.24
0.46
0.69
*
0.21
0.34
0.89
*
0.57
*
0.36
0.53
*
0.77
*
0.32
0.54
*
0.16
0.1) CI
4.4 (2.3– 5.2)
SVR
823 (469–
MAP
78 (10–
2028) 109) ICON
66 (22–
circulation than the uteroplacental circulation in women at moderate risk of preeclampsia. EIC may be a useful adjunct in assessing risk of fetal compromise Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.264
PP154. Relationship between recorded and reported snoring during pregnancy: Objective measurement versus questionnaire responses A. Robertson 1,2,*, P. Johnson 3, C. Thornton 1, A.-M. Whitton 1, S. Middleton 3, C. Sullivan 3, A. Hennesssy 1,2,4 (1 Medicine, University of Western Sydney, Australia, 2 Medicine, South Western Sydney Local Health District , Campbelltown, Australia, 3 Medicine, University of Sydney, Australia, 4 Vascular Immunology Group, Heart Research Institution, Sydney, Australia) Introduction: Snoring is a common symptom of sleep disordered breathing (SDB), a condition that is present in 4% of the general population. SDB is identified by snoring and repetitive cessation of breathing during sleep accompanied by repetitive hypoxia and has been found to be associated with hypertension, stroke and heart attack. There is not depth of knowledge examining the association between SDB and pregnancy outcomes. Objectives: To examine the prevalence of self reported snoring in pregnancy and the potential association between self reported snoring and the development of Hypertensive Disorders of Pregnancy (HDP) within a larger cohort from a prevalence of SDB in pregnancy study. Methods: Questionnaires were administered to pregnant women attending an outpatient’s antenatal clinic. The self reported snoring is a component of the Epworth scale. Pregnancy progression and outcome data were collected on all participants and analyse by IBM SPSS v.20e utilising Chi-square analysis, Student T test and logistic regression analysis. HDP diagnoses were in alignment with the SOMANZ (2009) diagnostic criteria. Results: Questionnaires were administered and outcomes collected on 2023 pregnancies. Snoring was reported by 49.2% of women. HDP affected 10.1% of the cohort, 3.3% of whom were preeclamptic. Of the pregnancies affected by HDP self reported snoring occurred in 57.7% in comparison to 43.3% who do not report snoring (p < 0.001). Conclusion: This would indicate that there is an association between self reported snoring and the development of HDP. Further analysis will be undertaken to model the effect of other potential risk factors such as maternal age, parity, pre-pregnancy BMI and other co morbidities.
100)
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.265
Conclusion: Maternal systemic hemodynamics can be conveniently acquired by EIC at the same time as routine obstetrical imaging. Our data suggest that maternal cardiovascular adaptation more closely reflects the fetoplacental
PP155. Relationship between overnight blood pressure and snoring during pregnancy
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
A. Robertson 1,2,*, P. Johnson 3, S. Middleton 3, M. Norman 3, A. Hennessy 1,2,4 (1 Medicine, University of Western Sydney, Australia, 2 Medicine, South Western Sydney Local District Health, Campbelltown, Australia, 3 Medicine, University of Sydney, Australia, 4 Medical Research, Heart Research Instutue, Sydney, Australia) Introduction: Snoring increases during the last trimester of pregnancy and is linked with both gestational hypertension and gestational diabetes. Previous studies have used questionnaires to determine the presence and severity of snoring. Objectives: The purpose of this study was to compare selfreported and objectively measured snoring in pregnancy. Methods: We studied 154 pregnant women. The results from the ‘‘Do you snore?’’ question of the Berlin questionnaire was compared with objectively measured snoring obtained during an at-home SonoMate study (a thin mattress overlay with sensors that measure breath sounds, breathing movement, heart sounds and body movement).
Recorded snoring
Questionnaire responses to ‘‘Do you snore?’’ Yes (%)
No (%)
Unsure (%) 50
20
45
24
50
Results: Ninety eight women (mean gestation 28 ± 7 weeks) answered ‘‘Yes’’ to the question ‘‘Do you snore?’’; 48 women answered ‘‘No’’; and 8 women answered ‘‘I don’t know’’. In the group who answered ‘‘Yes’’, recorded snoring average was 20 ± 19% of the night; in the ‘‘No’’ group, recorded snoring was 13 ± 22% and in the ‘‘I don’t know’’ group snoring was recorded as 22 ± 21%. There was a significant difference between the percentages of snoring recorded in women who answered ‘‘yes’’ compared to those who answered ‘‘no’’ (p = 0.04) but no other differences between groups. Conclusion: Snoring is very common in pregnancy, but questionnaire results provide only an approximate estimate of the presence of snoring. Importantly, significant snoring was present in 24% of women who denied snoring, and a significant number of women who reported snoring had minimal objectively recorded snoring. Objective measurement of snoring is needed to determine whether snoring is present in pregnant women. Disclosure of interest: None declared.
323
Introduction: High prevalence of pre-pregnancy weight excess, as well as evidence of increased risk of maternal and perinatal complications associated with nutritional states have been observed lately. Considering the possible ethnic and environmental influences few studies have assessed this risk in pregnant Brazilian women. Objectives: This study aimed at determining the prevalence of pre-pregnancy weight excess (overweight and obesity) and its association with maternal and perinatal complications in a Brazilian women population. Methods: We conducted a prospective cross-sectional study with 3,300 women who had birth care at the Asa Sul Regional Hospital of Brasília – Federal District (FD), from October 2009 to May 2010. Nutritional status was determined by body mass index (BMI), according to WHO criteria (2000): Low weight (BMI < 18.5 kg/m2), Normal weight (BMI between 18.5 and 24.9 kg/m2), Weight excess (BMI 25 kg/ m2), Overweight (BMI between 25 and 29.9 kg/m2) and obesity (BMI 30 kg/m2). The outcome variables were: pre-clinical complications such as chronic hypertension and diabetes, manifestation of gestational hypertension/preeclampsia, pregnancy duration and resolution as well as perinatal outcomes. The association among these variables was assessed using chi-square (Pearson) and Fisher’s exact test. Results were considered significant when p < 0.05. Results: In this population, weight excess before pregnancy had a prevalence of 27.2%, being 19.7% and 7.5% of pregnant women presenting, respectively, overweight and obesity. The prevalence of normal weight was 64.6% and low weight was 8.3%. Comparing the weight excess (BMI 25 kg/m2) group with the normal weight group it was observed predominant hypertension (23% vs. 10%) and diabetes (10.1% vs. 3.6%), prolonged pregnancy (14.4% vs. 10.7%) and cesarean section rate (58.1% vs. 47.2%) in the weight excess group. Newborn weight equal to or greater than 4,000 g (9.5% vs. 4.5%) as well as fetal macrosomia (14.6% vs. 7.4%) also predominated in weight excess group. The comparison among the groups normal weight, overweight and obesity showed predominance of hypertension, diabetes cesarean section rate, newborns weight and fetal macrosomia in the obesity group. Conclusion: In the population analyzed, the prevalence of pre-pregnancy weight excess, particularly obesity, was high and associated with maternal and perinatal complications. Weight excess pre-pregnancy should be considered a risk to the pregnancy, demanding different obstetric care. Efforts should be made so that, in the pre-pregnancy period, women’s weight can be as close to the normal weight as possible.
doi:10.1016/j.preghy.2012.04.266
Disclosure of interest: None declared. PP156. High prevalence of pre-pregnancy overweight and obesity associated with maternal and perinatal complications D.G. Cidade 1, P.R. Margotto 1, A.C.B.S. Guedes 1, A.A. Rocha 1, F.R. Assis 1, F.F. Cardoso 1, R.C.R. Lemes 1, V.T.M. Borges 2,*, J.C. Peracoli 2 (1 Health Sciences College, Brasilia, Federal District, Brazil, 2 Botucatu Medical School, Sao Paulo State University, Botucatu, Brazil)
doi:10.1016/j.preghy.2012.04.267
PP157. Risk of preeclampsia in pregnant women with gestational diabetes in Alberta K.A. Nerenberg 1,2,*, J.A. Johnson 3, P. Kaul 1 (1 Medicine, University of Alberta, Edmonton, Canada, 2 Obstetrics &
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
often associated with compromise in the other circulations, although the assessment of maternal vascular function by conventional means is cumbersome and expensive. Objectives: We sought to assess maternal hemodynamic function with a noninvasive cardiographic monitor, and to correlate the findings to both uteroplacental and fetoplacental vascular resistance. Methods: We measured cardiac output and index (CO, CI), systemic vascular resistance (SVR), mean arterial pressure (MAP) and an index of contractility (ICON) with a novel electrical impedance cardiograph (Aesculon EIC System, Cardiotronic, USA) that provides a volume independent estimate of cyclical blood flow velocity. We enrolled high-risk subjects between 22 and 25 weeks who were referred for assessment of fetal growth and uterine artery Dopplers due to abnormalities of serum screening analytes or other risk factors for preeclampsia. Doppler measurements of blood flow in the uterine arteries (pulsatility index, PI) and umbilical artery (systolic: diastolic ratio, S/D) were obtained by ultrasound (Voluson E8, GE Healthcare, Inc.), along with the fetal weight percentile (FW%). Data were expressed as medians (+/ range), and analyzed with Spearman’s correlation coefficient, R. Statistical significance was set to p = 0.05. Results: Electrical impedance cardiography (EIC) data was collected from seventeen subjects. There were no measurement failures. The median gestational age was 24.3 weeks and the BMI was 26.4 (21–47). The median PI, S/D and FW% were 0.96 (0.47–2.1), 3.3 (2.6–7.1), and 53% (6–82%). EIC results and their relationship to uterine and umbilical Dopplers and fetal growth are shown in Table 1. There were no significant correlations between maternal systemic hemodynamic parameters and uterine artery PI. On the other hand, maternal cardiac function was strongly related to the umbilical artery S/D ratio, and SVR was uniquely related to the FW%.
EIC Hemodynamic
Median
Correlation with Dopplers
Parameter
(range)
and growth (Spearman R; *
CO
7.5 (4.0–
= p < 0.05)
Uterine
Umbilical
PI
S/D
FW%
0.29
0.72
*
0.24
0.46
0.69
*
0.21
0.34
0.89
*
0.57
*
0.36
0.53
*
0.77
*
0.32
0.54
*
0.16
0.1) CI
4.4 (2.3– 5.2)
SVR
823 (469–
MAP
78 (10–
2028) 109) ICON
66 (22–
circulation than the uteroplacental circulation in women at moderate risk of preeclampsia. EIC may be a useful adjunct in assessing risk of fetal compromise Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.264
PP154. Relationship between recorded and reported snoring during pregnancy: Objective measurement versus questionnaire responses A. Robertson 1,2,*, P. Johnson 3, C. Thornton 1, A.-M. Whitton 1, S. Middleton 3, C. Sullivan 3, A. Hennesssy 1,2,4 (1 Medicine, University of Western Sydney, Australia, 2 Medicine, South Western Sydney Local Health District , Campbelltown, Australia, 3 Medicine, University of Sydney, Australia, 4 Vascular Immunology Group, Heart Research Institution, Sydney, Australia) Introduction: Snoring is a common symptom of sleep disordered breathing (SDB), a condition that is present in 4% of the general population. SDB is identified by snoring and repetitive cessation of breathing during sleep accompanied by repetitive hypoxia and has been found to be associated with hypertension, stroke and heart attack. There is not depth of knowledge examining the association between SDB and pregnancy outcomes. Objectives: To examine the prevalence of self reported snoring in pregnancy and the potential association between self reported snoring and the development of Hypertensive Disorders of Pregnancy (HDP) within a larger cohort from a prevalence of SDB in pregnancy study. Methods: Questionnaires were administered to pregnant women attending an outpatient’s antenatal clinic. The self reported snoring is a component of the Epworth scale. Pregnancy progression and outcome data were collected on all participants and analyse by IBM SPSS v.20e utilising Chi-square analysis, Student T test and logistic regression analysis. HDP diagnoses were in alignment with the SOMANZ (2009) diagnostic criteria. Results: Questionnaires were administered and outcomes collected on 2023 pregnancies. Snoring was reported by 49.2% of women. HDP affected 10.1% of the cohort, 3.3% of whom were preeclamptic. Of the pregnancies affected by HDP self reported snoring occurred in 57.7% in comparison to 43.3% who do not report snoring (p < 0.001). Conclusion: This would indicate that there is an association between self reported snoring and the development of HDP. Further analysis will be undertaken to model the effect of other potential risk factors such as maternal age, parity, pre-pregnancy BMI and other co morbidities.
100)
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.265
Conclusion: Maternal systemic hemodynamics can be conveniently acquired by EIC at the same time as routine obstetrical imaging. Our data suggest that maternal cardiovascular adaptation more closely reflects the fetoplacental
PP155. Relationship between overnight blood pressure and snoring during pregnancy
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
A. Robertson 1,2,*, P. Johnson 3, S. Middleton 3, M. Norman 3, A. Hennessy 1,2,4 (1 Medicine, University of Western Sydney, Australia, 2 Medicine, South Western Sydney Local District Health, Campbelltown, Australia, 3 Medicine, University of Sydney, Australia, 4 Medical Research, Heart Research Instutue, Sydney, Australia) Introduction: Snoring increases during the last trimester of pregnancy and is linked with both gestational hypertension and gestational diabetes. Previous studies have used questionnaires to determine the presence and severity of snoring. Objectives: The purpose of this study was to compare selfreported and objectively measured snoring in pregnancy. Methods: We studied 154 pregnant women. The results from the ‘‘Do you snore?’’ question of the Berlin questionnaire was compared with objectively measured snoring obtained during an at-home SonoMate study (a thin mattress overlay with sensors that measure breath sounds, breathing movement, heart sounds and body movement).
Recorded snoring
Questionnaire responses to ‘‘Do you snore?’’ Yes (%)
No (%)
Unsure (%) 50
20
45
24
50
Results: Ninety eight women (mean gestation 28 ± 7 weeks) answered ‘‘Yes’’ to the question ‘‘Do you snore?’’; 48 women answered ‘‘No’’; and 8 women answered ‘‘I don’t know’’. In the group who answered ‘‘Yes’’, recorded snoring average was 20 ± 19% of the night; in the ‘‘No’’ group, recorded snoring was 13 ± 22% and in the ‘‘I don’t know’’ group snoring was recorded as 22 ± 21%. There was a significant difference between the percentages of snoring recorded in women who answered ‘‘yes’’ compared to those who answered ‘‘no’’ (p = 0.04) but no other differences between groups. Conclusion: Snoring is very common in pregnancy, but questionnaire results provide only an approximate estimate of the presence of snoring. Importantly, significant snoring was present in 24% of women who denied snoring, and a significant number of women who reported snoring had minimal objectively recorded snoring. Objective measurement of snoring is needed to determine whether snoring is present in pregnant women. Disclosure of interest: None declared.
323
Introduction: High prevalence of pre-pregnancy weight excess, as well as evidence of increased risk of maternal and perinatal complications associated with nutritional states have been observed lately. Considering the possible ethnic and environmental influences few studies have assessed this risk in pregnant Brazilian women. Objectives: This study aimed at determining the prevalence of pre-pregnancy weight excess (overweight and obesity) and its association with maternal and perinatal complications in a Brazilian women population. Methods: We conducted a prospective cross-sectional study with 3,300 women who had birth care at the Asa Sul Regional Hospital of Brasília – Federal District (FD), from October 2009 to May 2010. Nutritional status was determined by body mass index (BMI), according to WHO criteria (2000): Low weight (BMI < 18.5 kg/m2), Normal weight (BMI between 18.5 and 24.9 kg/m2), Weight excess (BMI 25 kg/ m2), Overweight (BMI between 25 and 29.9 kg/m2) and obesity (BMI 30 kg/m2). The outcome variables were: pre-clinical complications such as chronic hypertension and diabetes, manifestation of gestational hypertension/preeclampsia, pregnancy duration and resolution as well as perinatal outcomes. The association among these variables was assessed using chi-square (Pearson) and Fisher’s exact test. Results were considered significant when p < 0.05. Results: In this population, weight excess before pregnancy had a prevalence of 27.2%, being 19.7% and 7.5% of pregnant women presenting, respectively, overweight and obesity. The prevalence of normal weight was 64.6% and low weight was 8.3%. Comparing the weight excess (BMI 25 kg/m2) group with the normal weight group it was observed predominant hypertension (23% vs. 10%) and diabetes (10.1% vs. 3.6%), prolonged pregnancy (14.4% vs. 10.7%) and cesarean section rate (58.1% vs. 47.2%) in the weight excess group. Newborn weight equal to or greater than 4,000 g (9.5% vs. 4.5%) as well as fetal macrosomia (14.6% vs. 7.4%) also predominated in weight excess group. The comparison among the groups normal weight, overweight and obesity showed predominance of hypertension, diabetes cesarean section rate, newborns weight and fetal macrosomia in the obesity group. Conclusion: In the population analyzed, the prevalence of pre-pregnancy weight excess, particularly obesity, was high and associated with maternal and perinatal complications. Weight excess pre-pregnancy should be considered a risk to the pregnancy, demanding different obstetric care. Efforts should be made so that, in the pre-pregnancy period, women’s weight can be as close to the normal weight as possible.
doi:10.1016/j.preghy.2012.04.266
Disclosure of interest: None declared. PP156. High prevalence of pre-pregnancy overweight and obesity associated with maternal and perinatal complications D.G. Cidade 1, P.R. Margotto 1, A.C.B.S. Guedes 1, A.A. Rocha 1, F.R. Assis 1, F.F. Cardoso 1, R.C.R. Lemes 1, V.T.M. Borges 2,*, J.C. Peracoli 2 (1 Health Sciences College, Brasilia, Federal District, Brazil, 2 Botucatu Medical School, Sao Paulo State University, Botucatu, Brazil)
doi:10.1016/j.preghy.2012.04.267
PP157. Risk of preeclampsia in pregnant women with gestational diabetes in Alberta K.A. Nerenberg 1,2,*, J.A. Johnson 3, P. Kaul 1 (1 Medicine, University of Alberta, Edmonton, Canada, 2 Obstetrics &
