316 SPO Abstracts

65 THE EFFECT Of IlATERIIAl CIGNIETTE SIIIKING 011 IlATERIIAl AlII! IEOIIATAL PRE6IIAICY OUTCOMES. S. Cl iver: R. Goldenberg. J. lams. R. Davis R. Copperx. Dept. Ob-Gyn. University of Alabama at Birmingham. OBJECTIVE: To study the effect of maternal cigarette smoking on adverse maternal and neonah 1 pregnancy outcomes. STillY DESI6I: This prospective study included over 20.000 women at five centers who participated in the March of Dimes Prematurity Prevention Study. The population was 4B% black. 3S% white. and 14% hispanic. Smoking history was obtained by self­report at a mean gestational age of 17 weeks. Twenty-five percent of the women reported smoki ng duri ng pregnancy and 11% smoked over 10 cigarettes per day. Multiple births were excluded from the analysis. The risk of each adverse outcome was evaluated for smokers vs. non-smokers. and for subgroups of smokers stratified by the number of cigarettes smoked per day: 1-10. 11-20. and> 20. RESUlTS: Relative Risks (RR) of Adverse Outcomes of Pregnancy

for Smokers vs. Non-Smokers RR 95% CI

Fetal Growth Restriction 1-:87 (1.7l.2.05) Preterm Delivery: Spontaneous 1.38 (1.20. 1.58)

PROM 1.43 (1.20. 1.S9) Indicated 1.22 (1.00. 1.48)

Stillbirth 1.S2 (1.23. 2.1S) Major Anomaly 1.38 (1.05. 1.81) Abruption (11+ vs. <11 cigs/day) 1.74 (1.21. 2.49) Preeclampsia/Eclampsia O.SO (0.51. 0.71) Chronic Hypertension 0.79 (O.SS. 0.95) Maternal Infection 0.S3 (0.48. 0.82) Pyelonephritis 1.45 (1.09. 1.93)

COIICLUSIOllS: Maternal smoking is associated with a significantly increased risk of fetal growth restriction. preterm delivery. major anomalies. and abruption. but a decreased risk of preeclampsia and chronic hypertension. Interestingly. in this data set. smoking was associated with an increased risk of pyelonephritis. but a decreased risk of maternal perinatal infection.

66 ~ SECORD TRIMESTER IIUMAH CHORIONIC GONADOTROPIN AND PREGNANCY IRDUCED HYPERTENSION. TK Sorensenx, MA Williamsx, RW Zingheimx, SJ ClementX, DE Hickok. Swedish Medical Center, Seattle, Washington. OBJECTIVEs Pregnancy induced hypertension (PIH) is believed to be a disorder of vascular endothelium, possibly focused in the placenta. Markers such as cellular fibronectin appear early in patients destined to develop PIH. We hypothesized that patients with elevated second trimester levels of human chorionic gonadaotropin (hCG) would have higher rates of PIH. STUDY DESIGNs We conducted a cohort study, using a database of patients undergoing second trimester serum screening for Down syndrome and who delivered at our institution between January 1990 and August 1991. We included all 180 women with hCG levels ~2.0 multiples of the median (MOM). A sequential sample of 369 women with hCG levels <2.0 MOM served as the referent group. Standard ACOG definition. of PIH and proteinuria ware u.ad. RESULTS: Patients with elevated heG levels were at increased risk for PIH (OR=1.7, 95% CI 1.2-2.4) and proteinuric PIH (OR=5.1, 95% CI 1.6-16.2). Adjusting for potential confounding factors did not alter these associations. CONCLUSIONS: Patients with elevated hOG appear to be at higher risk of PIH and proteinuric-PIH. Second trimester hCG levels should be further investigated as a potential marker for PIH.

January 1993 Am J Obstet Gynecol

67 MATERNAL SERUM THROMBOXANE a. REDUCTION VERSUS PREGNANCY OUTCOME IN A LOW-DOSE ASPIRIN TRIAL. J....tliwIb.. R. Goldenberg. C. Parker: M. DuBard: R. Copper: G. Cutter.' Dept. of OB/GYN. University of Alabama at Birmingham. Birmingham. AL. OBJECTIVE: To determine if a decrease in maternal serum thromboxane B. (TxB.lls associated with improvement in pregnancy outcomes in a Iow·dose aspirin (ASA) trial. STUDY DESIGN: 606 healthy nulliparous women with a singleton gestation were randomized at 24 weeks to either 60 mg of ASA or placebo treatment. Serum thromboxane B2 values were obtained at randomization. 29-31 weeks. 34-36 weeks and at delivery. Following delivery and without knowledge of patient outcome or group assignment. patients were categorized as a marked (4-fold or to less than 1000 pg/ml). moderate (2-fold or greater) or no evidence of a reduction in TxB2. RESULTS: Of 606 entrants. 92% had sufficient TxB2 determinations to allow categorization. In the ASA group. 223 of 283 (78%) women had a marked or moderate reduction in TxB. compared to 91 of 275 (33%) in the placebo group. In the ASA group. women with a marked or moderate reduction in TxB2 compared to no reduction had a greater birthweight (BW) (3320 vs. 3135 g) p=.04 and less intrauterine growth retardation (IUGR) (6/223 vs 6160) p=.013. In the placebo group. those with a marked or moderate reduction in TxB2 also had greater BW (3299 vs. 3116 g) p=.OO8. When the ASA and placebo groups were combined. women with a marked or moderate TxB2 reduction had less preeclampsia 1.9% (61314) vs. 5.7% (14/244) (p=.016). less preterm delivery (5.7% vs. 10.7",4,; p=.032). less IUGR 9/314 (2.9%) vs. 17/244 (7",4,) p=O.023 and a mean BW of 3314 g vs. 3121 9 (p=.OOOl) compared to women without a reduction in TxB2. CONCLUSION: Women in a lOW-dose ASA trial with a longitudinal reduction in serum TxS. had less preeclampsia and IUGR and a higher BW than women with no change in TxB2.

68 QUANTITATIVE DIFFERENCES IN CYCLOOXYGENASE GENE EXPRESSION IN ENDOMETRIUM AND DECIDUA. K. Shaw, C. Ng·, B. Kovacs·. Dept.ObIGyn. Univ. of So. Calif. School of Medicine. Los Angeles. CA OBJECTIVE: The enzymatic activity of cyclooxygenase (COX). a key enzyme in prostaglandin synthesis. has been identified in variolls tissues. The purpose of this study was to determine if quantitative differences in COX gene expression occur in association with decidualization of the endometriwn and if COX gene expression is altered in patients with preeclampsia. STUDY DESIGN: Endometriwn was obtained at time of hysterectomy in reproductive age women and decidua was obtained at time of cesarean section. Total RNA was extracted from these tissues and quantitated. Specific primers were designed to detect specific regions of the COX gene and the gene for glyceraldehyde 3 phosphate dehydrogenase (G3PDH). Reverse transcription polymerase chain reaction (RT-PCR) was conducted to determine gene expression. RESUL TS:Using the specific primers, PCR successfully detected G3PDH and COX transcripts in all samples. Nonspecific amplication was not evident with either primer set. COX gene transcript levels were IO-fold greater in endometriwn compared to decidua based upon standardization to G3PDH gene expression. There was no apparent difference in decidual COX gene expression between nonnotensive versus hypertensive cases. CONCLUSIONS: Decidualization at' nonnal endometriwn appears to result in down-regulation of COX gene expression. No such down­regulation is evident in G3PDH gene expression. Preeclampsia does not appear to be associated with alterations in decidual COX gene expression.