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240 THE USE OF POTENTIALLY HARMFUL OVER-THE-COUNTER MEDICA- TIONS IN PREGNANCY JERRIE REFUERZO 1 , SEAN BLACKWELL 2 , ROBERT SOKOL 2 , LORRAINE LAJEUNESSE 3 , KATHERINE FIRCHAU 1 , MICHAEL KRUGER 1 , YORAM SOROKIN 4 , 1 Wayne State University, Obstet- rics and Gynecology, Detroit, MI 2 Wayne State University, Obstetrics/ Gynecology, Detroit, MI 3 Wayne State University, Obstetrics and Gynecology, Detroit, MI 4 Wayne State University, Ob/Gyn/Maternal Fetal Med, Detroit, MI OBJECTIVE: Many women are not aware of common medications that may be harmful and should be avoided during pregnancy. The purpose of our study was to determine the frequency of potentially harmful medication use in pregnancy. STUDY DESIGN: A prospective, observational study was performed at a university-based, tertiary care hospital. After delivery, but prior to hospital discharge, postpartum women were asked to complete a detailed questionnaire that included over 120 medications. Patients were asked to identify any and all medications used during pregnancy and to describe the indication for the medication. Maternal demographics and clinical characteristics were also recorded. RESULTS: 418 patients completed the questionnaire. The demographic characteristics of the study group are as follows: maternal age 24.7 ± 6.0 years, African American race 89.7%, Medicaid insurance status 81.1%, some college education 24.6%. Potentially harmful medications were consumed in pregnancy by 14.1% of patients. Forty-two patients (10.1%) reported using ibuprofen during pregnancy. Patients obtained these medications over-the-counter (OTC) for the following reasons: headache (40.5%), generalized pain (28.6%), toothache (14.3%), cramping (4.8%), and not known (9.5%). Twenty patients (4.8%) reported using aspirin during pregnancy primarily for analgesic reasons. Four patients reported consuming both ibuprofen and aspirin. One patient admitted using doxycycline to treat an infection. There were no differences in race, education level, or Medicaid insurance status between patients who used and did not use potentially harmful medications in pregnancy. CONCLUSION: The use of potentially harmful medications in pregnancy occurred in 14.1% of patients. Patient awareness and education about prescribed and OTC medications with recommendations for pregnant condition should be provided by all clinicians caring for pregnant women. 241 SMOKING CESSATION IN PREGNANCY (SCIP) GRAHAM ASHMEAD 1 , LOYAL COSHWAY 1 , HEIDI RUMANCIK 1 , ROSE SEVCIK 1 , SAEID AMINI 1 , MELISSA HERBST 1 , 1 MetroHealth Medical Center at CWRU School of Medicine, Maternal Fetal Medicine, Cleveland, OH OBJECTIVE: To provide prenatal health smoking cessation in pregnancy (SCIP) services for uninsured or low-income patients in a high-risk pregnancy clinic with a high incidence of smoking (29%) and low birthweight (1 in 6 babies). The goal was to create a successful model SCIP program for implementation in other pregnancy clinics in the greater Cleveland community. STUDY DESIGN: The study design was that of a prospective longitudinal observational clinical study. The SCIP program was based on one-on-one counseling at prenatal visits by nurse coordinators implementing American Cancer Society smoking cessation protocols using the Fresh Start model. Information was obtained at each prenatal and postnatal visit including risk factors, smoking status, and level of counseling. Gift certificates were provided as incentives. Extensive surveys were obtained initially and 6 weeks post partum. SCIP information was recorded utilizing the EPIC patient electronic medical record. RESULTS: 114 patients were counseled and 76 (67%) were smokers during the current pregnancy. The age for starting smoking (mean 16.3, SD 3.9) ranged from 8 to 29, with 13.7% smoking by age 12, 45.2% by age 15, 53.4% by age 16, 67.1% by age 17, and 83.6% by age 18. 85.1% smoked 10 cigarettes or more prior to entering the SCIP program. 83.1% of the smokers had 12 years or less of education. 86.8% were exposed to secondhand smoke. 15 of the smokers (19.7%) had quit smoking before their first visit in SCIP, and of these, 8 continued not to smoke and 7 were lost to follow-up. Of the 61 ongoing smokers, 24 (39.3%) were lost to follow-up, 18 (29.5%) cut back on smoking (10 setting a quit date), 9 quit smoking (14.7%), 8 (13.1%) showed no change, and 2 (3.3%) increased slightly. The decreased smoking with the SCIP program was significant to P < .0005. CONCLUSION: The SCIP program demonstrated successful intervention to decrease smoking in a high-risk pregnancy population. Future objectives include smoking cessation prediction, follow-up, and spread of SCIP model. Supported by March of Dimes. 242 BINGE DRINKING DURING PREGNANCY AND CHILD VERBAL IQ AT AGE 6-7 YEARS BETH NORDSTROM 1 , VIRGINIA DELANEY-BLACK 2 , JOEL AGER 3 , JAMES JANISSE 3 , JOHN HANNIGAN 4 , CHANDICE COVINGTON 5 , ROBERT SOKOL 4 , 1 East Tennessee State University, Family Medicine, Johnson City, TN 2 Wayne State University, Pediatrics, Detroit, MI 3 Wayne State University, Center for Healthcare Effectiveness Research, Detroit, MI 4 Wayne State University, Obstetrics/Gynecology, Detroit, MI 5 University of California at Los Angeles, Nursing, Los Angeles, CA OBJECTIVE: Prenatal alcohol exposure has been associated with impaired cognitive development of the offspring. To better characterize this relationship, the current investigation examined the relation between amount and pattern of prenatal alcohol exposure and child verbal IQ. STUDY DESIGN: Prenatal alcohol exposure data were prospectively collected by maternal self-report during pregnancy. Two variables were calculated: amount (oz of absolute alcohol/day averaged across pregnancy) and pattern (dichotomous comparison of those exposed to 5 or more drinks/ occasion at least once every 2 weeks, with those with less exposure). At age 6-7 years, children and their caretakers were evaluated in our lab, and the WPPSI was administered. Data analyses involved hierarchical multiple regression. RESULTS: Data were available for 537 urban African American first-grade children. After control for prenatal exposure to cigarettes and cocaine and postnatal factors including SES, violence exposure, and quality of home environment, amount of prenatal alcohol exposure was not significantly related to verbal or performance IQ, and drinking pattern was unrelated to performance IQ (P > .05). However, pattern of exposure was significantly related to verbal IQ after control for confounding (P < .05). Compared with those exposed to lesser amounts, children exposed to 5 or more drinks/ occasion at least once every 2 weeks were 1.7 times more likely to have verbal IQ scores below 70 (41% vs 24%). CONCLUSION: A binge pattern of maternal drinking, but not amount of prenatal alcohol exposure, predicted a significantly lower verbal IQ in our sample of first-grade African American children, with a nearly twofold increase in risk for mental retardation. These data suggest that for some effects, the pattern of drinking may be more important than the amount of alcohol per se consumed across pregnancy and that pattern of intake should be assessed during preconceptional and prenatal care. 243 BINGE DRINKING DURING PREGNANCY AND CHILD BEHAVIOR PROB- LEMS AT AGE 6-7 BETH NORDSTROM 1 , VIRGINIA DELANEY-BLACK 2 , CHANDICE COVINGTON 3 , JAMES JANISSE 4 , JOHN HANNIGAN 5 , JOEL AGER 4 , ROBERT SOKOL 5 , 1 East Tennessee State University, Family Medicine, Johnson City, TN 2 Wayne State University, Pediatrics, Detroit, MI 3 University of California at Los Angeles, Nursing, Los Angeles, CA 4 Wayne State University, Center for Healthcare Effectiveness Research, Detroit, MI 5 Wayne State University, Obstetrics/Gynecology, Detroit, MI OBJECTIVE: Prenatal alcohol exposure can be associated with aberrant neurobehavioral development. The current investigation examined the relation between amount and pattern of prenatal alcohol exposure and teacher-reported child behavior problems. STUDY DESIGN: Prenatal alcohol exposure data were prospectively collected by maternal self-report during pregnancy, and two variables were calculated: amount (oz of absolute alcohol/day averaged across pregnancy) and pattern (dichotomous comparison of those exposed to 5 or more drinks/ occasion at least once every 2 weeks, with those lesser exposed). At age 6-7, children and their caretakers were evaluated in our laboratory, and permission was obtained to collect teacher behavior ratings (TRF). Data analysis involved hierarchical multiple regression. RESULTS: Data were available for 499 urban African American first-grade children. After control for prenatal exposure to cigarettes and cocaine and post- natal factors including SES, violence exposure, and quality of home environment, amount of exposure was not significantly related to aggressive or delinquent behavior, and pattern was unrelated to aggressive behavior (P > .05). However, pattern of exposure was significantly related to teacher report of delinquent behavior after control for confounding (P < .05). Compared with those exposed to lesser amounts, children exposed to 5+ drinks at least once every 2 weeks were 2.5 times more likely to have clinically significant levels of delinquent behavior (17% vs 7%). CONCLUSION: Distinct adverse behavioral effects were identified among children who were exposed to binge drinking prenatally. These data suggest that in preconceptional and prenatal care, clinicians should attend to the pattern of alcohol intake, i.e., bingeing. Fetal exposure to maternal binge drinking is a risk for long-term behavioral abnormality. Volume 189, Number 6 Am J Obstet Gynecol SMFM Abstracts S129

Smoking cessation in pregnancy (SCIP)

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240 THE USE OF POTENTIALLY HARMFUL OVER-THE-COUNTER MEDICA-TIONS IN PREGNANCY JERRIE REFUERZO1, SEAN BLACKWELL2,ROBERT SOKOL2, LORRAINE LAJEUNESSE3, KATHERINE FIRCHAU1,MICHAEL KRUGER1, YORAM SOROKIN4, 1Wayne State University, Obstet-rics and Gynecology, Detroit, MI 2Wayne State University, Obstetrics/Gynecology, Detroit, MI 3Wayne State University, Obstetrics and Gynecology,Detroit, MI 4Wayne State University, Ob/Gyn/Maternal Fetal Med, Detroit,MI

OBJECTIVE: Many women are not aware of common medications that maybe harmful and should be avoided during pregnancy. The purpose of our studywas to determine the frequency of potentially harmful medication use inpregnancy.

STUDY DESIGN: A prospective, observational study was performed ata university-based, tertiary care hospital. After delivery, but prior to hospitaldischarge, postpartum women were asked to complete a detailed questionnairethat included over 120 medications. Patients were asked to identify any and allmedications used during pregnancy and to describe the indication for themedication. Maternal demographics and clinical characteristics were alsorecorded.

RESULTS: 418 patients completed the questionnaire. The demographiccharacteristics of the study group are as follows: maternal age 24.7 ± 6.0 years,African American race 89.7%, Medicaid insurance status 81.1%, some collegeeducation 24.6%. Potentially harmfulmedications were consumed in pregnancyby 14.1% of patients. Forty-two patients (10.1%) reported using ibuprofenduring pregnancy. Patients obtained thesemedications over-the-counter (OTC)for the following reasons: headache (40.5%), generalized pain (28.6%),toothache (14.3%), cramping (4.8%), and not known (9.5%). Twenty patients(4.8%) reported using aspirin during pregnancy primarily for analgesic reasons.Four patients reported consuming both ibuprofen and aspirin. One patientadmitted using doxycycline to treat an infection. There were no differences inrace, education level, or Medicaid insurance status between patients who usedand did not use potentially harmful medications in pregnancy.

CONCLUSION: The use of potentially harmful medications in pregnancyoccurred in 14.1% of patients. Patient awareness and education aboutprescribed and OTC medications with recommendations for pregnantcondition should be provided by all clinicians caring for pregnant women.

241

242 BINGE DRINKING DURING PREGNANCY AND CHILD VERBAL IQ ATAGE 6-7 YEARS BETH NORDSTROM1, VIRGINIA DELANEY-BLACK2, JOELAGER3, JAMES JANISSE3, JOHN HANNIGAN4, CHANDICE COVINGTON5,ROBERT SOKOL4, 1East Tennessee State University, Family Medicine,Johnson City, TN 2Wayne State University, Pediatrics, Detroit, MI 3WayneState University, Center for Healthcare Effectiveness Research, Detroit, MI4Wayne State University, Obstetrics/Gynecology, Detroit, MI 5University ofCalifornia at Los Angeles, Nursing, Los Angeles, CA

OBJECTIVE: Prenatal alcohol exposure has been associated with impairedcognitive development of the offspring. To better characterize this relationship,the current investigation examined the relation between amount and pattern ofprenatal alcohol exposure and child verbal IQ.

STUDY DESIGN: Prenatal alcohol exposure data were prospectivelycollected by maternal self-report during pregnancy. Two variables werecalculated: amount (oz of absolute alcohol/day averaged across pregnancy)and pattern (dichotomous comparison of those exposed to 5 or more drinks/occasion at least once every 2 weeks, with those with less exposure). At age 6-7years, children and their caretakers were evaluated in our lab, and theWPPSI wasadministered. Data analyses involved hierarchical multiple regression.

RESULTS: Data were available for 537 urban African American first-gradechildren. After control for prenatal exposure to cigarettes and cocaine andpostnatal factors including SES, violence exposure, and quality of homeenvironment, amount of prenatal alcohol exposure was not significantly relatedto verbal or performance IQ, and drinking pattern was unrelated toperformance IQ (P > .05). However, pattern of exposure was significantlyrelated to verbal IQ after control for confounding (P < .05). Compared withthose exposed to lesser amounts, children exposed to 5 or more drinks/occasion at least once every 2 weeks were 1.7 times more likely to have verbal IQscores below 70 (41% vs 24%).

CONCLUSION: A binge pattern of maternal drinking, but not amount ofprenatal alcohol exposure, predicted a significantly lower verbal IQ in oursample of first-grade African American children, with a nearly twofold increasein risk for mental retardation. These data suggest that for some effects, thepattern of drinking may be more important than the amount of alcohol per seconsumed across pregnancy and that pattern of intake should be assessedduring preconceptional and prenatal care.

243 BINGE DRINKING DURING PREGNANCY AND CHILD BEHAVIOR PROB-LEMS AT AGE 6-7 BETH NORDSTROM1, VIRGINIA DELANEY-BLACK2,CHANDICE COVINGTON3, JAMES JANISSE4, JOHN HANNIGAN5, JOELAGER4, ROBERT SOKOL5, 1East Tennessee State University, FamilyMedicine, Johnson City, TN 2Wayne State University, Pediatrics, Detroit, MI3University of California at Los Angeles, Nursing, Los Angeles, CA 4WayneState University, Center for Healthcare Effectiveness Research, Detroit, MI5Wayne State University, Obstetrics/Gynecology, Detroit, MI

OBJECTIVE: Prenatal alcohol exposure can be associated with aberrantneurobehavioral development. The current investigation examined the relationbetween amount andpattern of prenatal alcohol exposure and teacher-reportedchild behavior problems.

STUDY DESIGN: Prenatal alcohol exposure data were prospectivelycollected by maternal self-report during pregnancy, and two variables werecalculated: amount (oz of absolute alcohol/day averaged across pregnancy) andpattern (dichotomous comparison of those exposed to 5 or more drinks/occasion at least once every 2 weeks, with those lesser exposed). At age 6-7,children and their caretakers were evaluated in our laboratory, and permissionwas obtained to collect teacher behavior ratings (TRF). Data analysis involvedhierarchical multiple regression.

RESULTS: Data were available for 499 urban African American first-gradechildren. After control for prenatal exposure to cigarettes and cocaine and post-natal factors including SES, violence exposure, and quality of homeenvironment, amount of exposure was not significantly related to aggressiveor delinquent behavior, and pattern was unrelated to aggressive behavior(P > .05). However, pattern of exposure was significantly related to teacherreport of delinquent behavior after control for confounding (P < .05).Compared with those exposed to lesser amounts, children exposed to 5+ drinksat least once every 2 weeks were 2.5 timesmore likely to have clinically significantlevels of delinquent behavior (17% vs 7%).

CONCLUSION: Distinct adverse behavioral effects were identified amongchildren who were exposed to binge drinking prenatally. These data suggest thatin preconceptional and prenatal care, clinicians should attend to the pattern ofalcohol intake, i.e., bingeing. Fetal exposure to maternal binge drinking is a risk

Volume 189, Number 6Am J Obstet Gynecol

SMFM Abstracts S129

SMOKING CESSATION IN PREGNANCY (SCIP) GRAHAM ASHMEAD1,LOYAL COSHWAY1, HEIDI RUMANCIK1, ROSE SEVCIK1, SAEID AMINI1,MELISSA HERBST1, 1MetroHealth Medical Center at CWRU School ofMedicine, Maternal Fetal Medicine, Cleveland, OH

OBJECTIVE: To provide prenatal health smoking cessation in pregnancy(SCIP) services for uninsured or low-income patients in a high-risk pregnancyclinic with a high incidence of smoking (29%) and low birthweight (1 in 6babies). The goal was to create a successful model SCIP program forimplementation in other pregnancy clinics in the greater Cleveland community.

STUDY DESIGN: The study design was that of a prospective longitudinalobservational clinical study. The SCIP program was based on one-on-onecounseling at prenatal visits by nurse coordinators implementing AmericanCancer Society smoking cessation protocols using the Fresh Start model.Information was obtained at each prenatal and postnatal visit including riskfactors, smoking status, and level of counseling. Gift certificates were provided asincentives. Extensive surveys were obtained initially and 6 weeks post partum.SCIP information was recorded utilizing the EPIC patient electronic medicalrecord.

RESULTS: 114 patients were counseled and 76 (67%) were smokers duringthe current pregnancy. The age for starting smoking (mean 16.3, SD 3.9) rangedfrom 8 to 29, with 13.7% smoking by age 12, 45.2% by age 15, 53.4% by age 16,67.1% by age 17, and 83.6% by age 18. 85.1% smoked 10 cigarettes ormore priorto entering the SCIP program. 83.1% of the smokers had 12 years or less ofeducation. 86.8% were exposed to secondhand smoke. 15 of the smokers(19.7%) had quit smoking before their first visit in SCIP, and of these, 8continued not to smoke and 7 were lost to follow-up. Of the 61 ongoing smokers,24 (39.3%) were lost to follow-up, 18 (29.5%) cut back on smoking (10 settinga quit date), 9 quit smoking (14.7%), 8 (13.1%) showed no change, and 2(3.3%) increased slightly. The decreased smoking with the SCIP program wassignificant to P < .0005.

CONCLUSION: The SCIP program demonstrated successful interventionto decrease smoking in a high-risk pregnancy population. Future objectivesinclude smoking cessation prediction, follow-up, and spread of SCIP model.Supported by March of Dimes.

for long-term behavioral abnormality.