kroi0eo

ow

T

R

DI

ttasac

ttaF

r(soi[o

1

K

p

vtthtrac

9wprcswvd

Poster Session II Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity www.AJOG.org

STUDY DESIGN: This is a retrospective cohort study including 502,186singleton, nonanomalous pregnancies recorded in the 2008 CaliforniaBirth Registry, of which 125 were complicated by chronic kidney dis-ease. Outcomes recorded included preeclampsia, preterm delivery,neonatal death, intrauterine fetal demise, small for gestational age,low birthweight, and mode of delivery stratified for nulliparous andmultiparous patients. Chi squared tests and multivariable logistic re-gression analyses were used for statistical analysis.RESULTS: The rate of preterm delivery was 50.4% in patients with chronic

idney disease (CKD) compared to 8.4% (p�.001) in the controls. Theate of preeclampsia was 40.0% in CKD patients with a control group ratef 2.9% (p�.001). Neonatal death was rated at 3.5% in CKD versus 0.2%

n controls (p�.001) and intrauterine fetal demise at 6.4% in CKD and.3% in the control group (p�.001). Moreover, the overall rate of cesar-an sections were greater in women with CKD (51.2%) versus those with-ut (30.3%, p�.001) which differed by parity as well (Table).

CONCLUSION: Chronic kidney disease (CKD) is associated with an in-creased risk of preterm delivery, preeclampsia, gestational hypertension,neonatal death, intrauterine fetal demise, small for gestational age babies,low birthweight at term, and significantly increased rates of cesarean de-livery. These risks can be utilized to counsel patients with this chronicillness.

347 Recombinant human antithrombin (rhAT) for preventionf venous thromboembolism (VTE) in pregnant patientsith hereditary antithrombin deficiency (HD)

Michael Paidas1, Elizabeth Triche2, Andra James3,rina Ballard4, Simon Lowry5

1Yale University School of Medicine, Obstetrics, Gynecology andeproductive Sciences, New Haven, CT, 2Brown University School of

Medicine, Epidemiology, Providence, RI, 3National Institutes of Health,ivision of Blood Diseases and Resources, National; Heart, Lung, and Blood

nstitute, Bethesda, MD, 4GTC Biotherapeutics, Inc., GTC Biotherapeutics,Inc., Framingham, MA, 5GTC Biotherapeutics, Inc., GTC Biotherapeutics,Inc., Framingham, MAOBJECTIVE: HD is the most thrombogenic, and rarest, of inheritedhrombotic disorders. Management of these patients require anti-hrombin replacement when anticoagulation (AC) is withheld, suchs during surgery or delivery. In 2 studies that included pregnant andurgical HD patients, rhAT therapy prevented VTE. A retrospectivenalysis was conducted to assess rhAT safety and efficacy in a largeohort of pregnant HD patients.

STUDY DESIGN: Data from all pregnant HD patients in these two phasehree studies were pooled. rhAT dosing, based on weight and AT ac-ivity, began up to 24 hrs before scheduled cesarean delivery or at labornd continued for 3-14 days. Adverse events (AEs) were characterized.requency tabulations comprised the statistical analysis.

RESULTS: Among 21 patients, 19 had a VTE history. Mean (range)hAT therapy duration, loading dose, and infusion rate were 4.3 d0.9-14.0), 34.9 IU/kg (13.0-81.4), and 140.6 IU/kg/d (7.2-451.7), re-pectively. All patients achieved target mean AT activity (80%-120%f normal) during rhAT therapy. There were no confirmed VTEs dur-

ng rhAT treatment or within 7 (�1) d post dosing. Two VTE events1 deep venous thrombosis (DVT) and 1 pulmonary embolism (PE)]

Pregnancy outcomes in chronic kidneydisease: singleton pregnancies

ccurred 11 and 14 days after rhAT discontinuation, respectively.

S154 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

Four patients (19.0%) reported 6 serious AEs:DVT, PE, enterobactersepsis, pyrexia, wound hematoma, intra-abdominal hemorrhage(IAH), but only the IAH was considered probably related to rhAT.Importantly, the IAH was directly related to reinstitution of AC.CONCLUSION: This study, representing the largest cohort of pregnantHD patients in the world, found no VTEs during rhAT therapy orwithin 7 (�1) days post dosing. rhAT was safe and effective in preg-nant HD patients peripartum, the period of highest VTE risk andwhen AC is normally withheld. Pregnant HD patients may benefitfrom therapeutic, rather than prophylactic, AC post delivery to pro-tect against remote postpartum VTE events.

348 Pregnancy outcomes in women with0, 20, and 30 pound weight gain

Roxane Holt1, Jeanne Sheffield1, Donald McIntire1,enneth Leveno1

1UTSW Medical Center, Obstetrics and Gynecology, Dallas, TXOBJECTIVE: To evaluate the risk of incremental weight gain during

regnancy in all four WHO weight categories.STUDY DESIGN: Retrospective cohort study from a single institution in-olving a primarily Hispanic indigent population. From January 1, 2002o April 30, 2011, women presenting with a BMI recorded in the 1strimester and a subsequent delivery weight were included. The study co-ort included singleton infants, excluding preexisting maternal hyper-ension, overt and gestational DM, and anomalies. Women were catego-ized according to WHO weight categories. Pregnancy outcomes weressessed for each weight category by race and 10 pound weight gain in-rements. Standard methods were used for statistical analysis.

RESULTS: During the study period, 44,084 women were identified with03 (2%) underweight, 17,537 (40%) normal weight, 15,283 (35%) over-eight, and 10,361 (24%) obese. In Hispanic women, for every tenounds of weight gain, there was a significant decrease in fetal growthestriction, preterm birth, and stillbirth. In contrast, there was a signifi-ant increase in macrosomia, preeclampsia, labor induction, primary Ce-arean delivery, and shoulder dystocia (Example shown in Table). Thisas true across all weight categories though the incremental differencesaried. Black and non-Hispanic white women also show similar absoluteifferences though the incremental differences varied.

CONCLUSION: There are disadvantages to weight gain in pregnancy(e.g. macrosomia, primary Cesarean delivery); however, the benefitsof decreasing preterm birth, fetal growth restriction, and stillbirth aresignificant. The data presented as risk of increasing weight per tenpound increment in the four weight categories are useful for counsel-ing women regarding weight gain recommendations in pregnancy.

Risk of primary cesarean delivery andgrowth restriction with weight gain

013