716 Risk factors for neonatal complicationsrelated to placental dysfunctionMadeline Rice1

1Maternal-Fetal Medicine Units Network, for the Eunice Kennedy ShriverNational Institute of Child Health and Human Development, Bethesda, MDOBJECTIVE: To evaluate whether two neonatal complications that havebeen linked to placental dysfunction, small for gestational age (SGA)and preterm birth (PTB), share risk factors, including maternal pla-centa-related syndromes.STUDY DESIGN: Datawereabstractedbytrainedresearchstaff frommaternaland neonatal charts of deliveries occurring on randomly selected days repre-sentingone-thirdofdeliveriesacross25UShospitalsoverathree-yearperiod.This analysis was restricted to non-anomalous singleton deliveries(N�99,164). Stillbirths, which also have been linked to placental dysfunc-tion,wereexcludedduetotheirrarefrequencyinthiscohort(N�30;0.03%).The neonatal outcome categories were defined as: 1) SGA � 10th percentileand term; 2) PTB � 37 wks and not SGA; and 3) both SGA and PTB. Oddsratios and 95% CIs were estimated using multivariable multinomial logisticregression.RESULTS: The frequency of outcomes was 7.7% for SGA, 7.6% for PTBand 2.0% for both SGA and PTB. SGA and PTB shared several car-diovascular and obstetric history risk factors (e.g., chronic hyperten-sion [HTN], cigarette use, cocaine use, prior PTB). Increasing bodymass index was associated with decreasing odds of both SGA and PTB.Diabetes was associated with an increased odds of PTB, but a de-creased odds of SGA. Premature rupture of membranes was a strongrisk factor for PTB. With regards to maternal placenta-related syn-dromes, preeclampsia (PE) and abruption were significantly andstrongly associated with PTB. Abruption in the absence of gestationalhypertension or PE was not associated with SGA.CONCLUSION: These data support the concept of multiple risk factors,with shared and unshared pathways, leading to SGA and PTB. Ourresults, based on a large well-characterized cohort, also provide guid-ance to focus preventive strategies aimed at improving neonatal out-comes. Potentially modifiable risk factors for both SGA and PTB in-cluded chronic HTN, cigarette use and cocaine use. PE and abruptionwere particularly noteworthy risk factors for PTB.

717 Risk factors for maternal placenta-related syndromesMadeline Rice1

1Maternal-Fetal Medicine Units Network, for the Eunice Kennedy ShriverNational Institute of Child Health and Human Development, Bethesda, MDOBJECTIVE: To evaluate whether maternal outcomes related to a placentaletiology share risk factors using a large well-characterized cohort.STUDY DESIGN: Data were abstracted by trained clinical research stafffrom maternal and neonatal charts of deliveries occurring on com-puter-generated randomly selected days representing one-third of de-liveries across 25 US hospitals over a three-year period. This analysiswas restricted to non-anomalous singleton deliveries (N�99,164).The maternal outcome categories were defined as: 1) gestational hy-pertension (GHTN) in the absence of abruption; 2) preeclampsia(PE) in the absence of abruption; 3) abruption in the absence ofGHTN or PE; and 4) abruption in the presence of GHTN or PE. Oddsratios and 95% confidence intervals were estimated using multivari-able multinomial logistic regression.RESULTS: The frequency of outcomes was 3.4% for GHTN in the absence ofabruption,5.7%forPEintheabsenceofabruption,0.8%forabruptionintheabsenceofGHTNorPEand0.1%forabruptioninthepresenceofGHTNorPE.Thematernaloutcomessharedsomecardiovascularandobstetrichistoryrisk factors (e.g., chronic hypertension, prior preterm birth), but not all (e.g.,cigaretteusewasonlyassociatedwithabruption;pre-gestationaldiabetesandnulliparitywereassociatedwithPE,butnotabruption).Increasingbodymassindex was associated with increasing odds of GHTN and PE, but decreasingodds of abruption. Premature rupture of membranes was associated with anincreased odds of abruption, but a decreased odds of GHTN and PE.CONCLUSION: These data support the concept of multiple risk factors,with shared and unshared pathways, leading to maternal outcomesrelated to placental dysfunction. Of potentially modifiable risk fac-tors, chronic HTN may play an important role in both abruption andpregnancy-induced hypertensive disorders.

Odds ratios (95%CIs) from the multivariablemultinomial logistic regression modelfor neonatal complications linkedto placental dysfunction

www.AJOG.org Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health Poster Session V

Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology S301

718 First trimester maternal weight in USA continues to riseMark Evans1, Terrence Hallahan2, Hsiao-Pin Liu2,Jon Carmichael2, David Krantz2

1Comprehensive Genetics, Genetics, New York, NY, 2Perkin Elmer, NTDLabs, Melville, NYOBJECTIVE: To determine whether the average weight of pregnantwomen continues to increase between 2003 and 2011.STUDY DESIGN: First trimester maternal weight (MW) data (lb) wereevaluated on 1,677,116 patients, collected as part of first trimesteraneuploidy screening conducted between 2003 and 2011. The studypopulation was 65% Caucasian, 12% Hispanic, 10% African Ameri-can, 7% Asian, 3% Asian Indian and 3% other ethnic Groups. If apatient had more than one test during this time period data from oneof their tests was selected at random. Geometric mean maternalweight values were adjusted for age, gestational age at time of test andethnicity by determining the least-squares means based on ANOVAusing log-transformed weight values. The adjusted geometric meanmaternal weight values were then regressed against time (with stan-dard error of the coefficients adjusted for autocorrelation and numberof patients during each time period).RESULTS: Overall over the study time period, the average weight of thetotal population increased by 4.0% while the increase in the top 10%group was 7.3%. A majority of the increase occurred from 2003 to2007 (3.0% and 4.7% for the total population and top 10%, respec-tively). Regression analysis determined that the increase was not linearbut rather followed a polynomial quadratic pattern for both the over-all population as well as the top 10% (P value of the quadratic term �0.001 for both overall and top 10% of the population).CONCLUSION: The continuous increase in the mean MW particularlythe top 10% is of significant concern because of increased rate of

pregnancy complications, more difficult ultrasound examinations,reduced fetal fraction of DNA leading to poorer performance of NIPTtesting and the need to ensure that weight adjustment formulas usedfor aneuploidy screening are still applicable. The slowing of the trendin the increase in MW needs to be studied but is a positive sign forpublic health.

719 Analysis of spatial variation in prenatallydiagnosed congenital anomalies in IndianaElicia Harris1, Men-Jean Lee1, Michael Reger2, Jennifer Wessel2,Christian Litton1, Frank Schubert1, Alan Golichowski1

1Indiana University School of Medicine, Obstetrics and Gynecology,Indianapolis, IN, 2Indiana University School of Medicine, Public Health,Indianapolis, INOBJECTIVE: To determine if there are geographical clustering of con-genital anomalies across various zip codes, counties, and economicgrowth regions (agriculture vs. manufacturing industries) by Indiana.gov.STUDY DESIGN: This was a retrospective study from January 1, 2008 toJanuary 1, 2012 of 1112 individual cases of prenatally diagnosed con-genital anomalies detected on Level II ultrasound at the primary state-wide perinatal referral center for pregnant women whose fetuses re-quire Pediatric Surgery, ECMO, Pediatric Cardiology, and/orpregnancy termination. Geographic Information Systems (GIS) map-ping of the affected fetuses were performed using zip codes and countyof residence of the pregnant women using latitude and longitude ofmaternal residence during prenatal ultrasound. Population data wasobtained from the Indiana State Department of Vital Statistics by zipcode, county, and women of childbearing age for use as denominatorsfor rates calculations.RESULTS: Region 5 (Indianapolis) had the highest total number ofanomalous fetuses (55.8%), although only 28.15% of population re-sides in this region according to 2010 Census data. 4 zip codes inIndianapolis (Region 5) and 2 zip codes around South Bend (Region2) had the highest number of anomalies. However, when geomappingthe fetal anomaly rate by 100,000 population, only 1 zip code wasidentified as having 758 fetal anomalies per 100,000 population dur-ing this time period, while the next highest zip codes had only 165-251anomalies per 100,000 population. When the data was geomapped bycounty, St. Joseph County (South Bend), once again had the highestcongenital anomaly rate of 790 cases per 100,000 female population ofchild-bearing age (15-44 years) (Figure).CONCLUSION: There appears to be geographic clustering of prenatallydiagnosed fetal anomalies in particular zip codes and counties acrossthe state of Indiana. Further epidemiological studies are needed tocorrelate these clusters with environmental hazards and exposuresduring embryogenesis.

Odds ratios (95%CIs) from the multivariablemultinomial logistic regression model formaternal placenta-related syndromes

Increase in geometric meanmaternal weight by year

Geometric mean adjusted for age, gestational age and ethnicity.

Poster Session V Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health www.AJOG.org

S302 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013