577 Systemic inflammation response ofgrowth restricted premature newbornsT.F. McElrath1, E. Allred2, R. Fichorova3, A. Leviton2

1Harvard Medical School, Brigham & Women’s Hospital, Divisionof Maternal-Fetal Medicine, Boston, MA, 2Children’s Hospital,Neuroepidemiology, Boston, MA, 3Brigham &Women’s Hospital, OB/Gyn, Boston, MAOBJECTIVE: In-utero growth restriction (IUGR) presages health con-sequences later in life. We describe here a pattern of inflammation-related proteins characteristic of IUGR extremely preterm newbornsthat may explain these later consequences.STUDY DESIGN: 25 inflammation-related proteins were measured inblood collected on postnatal days 1, 7 and 14 from 939 infants bornbefore the 28th week of gestation using the Meso Scale Discoveryplatform with normalization to total protein. IUGR was defined as agestation-specific birth weight Z-score ��2. Multinomial logistic re-gression models calculated the odds ratios of protein concentrationsin the top quartile.RESULTS: The table presents statistically significant odds ratios (95%CI) of a top quartile concentration of the protein listed on the left.Each of the three postnatal days are listed at the top of each column fornewborns with a birth weight Z-score ��2 compared to those with abirth weight Z-score � �1.CONCLUSION: Independent of the preceding in-utero environment,premature IUGR neonates are at increased risk of an inflammatorypattern of blood proteins after the first 2 postnatal weeks.

578 A comparison of the risk of remaining undeliveredto the incidence of neonatal death from 34-41 weeksgestation in normal and complicated pregnanciesThaddeus P. Waters1, Stephen A. Myers2, Jennifer L. Bailit1

1MetroHealth Medical Center-Case Western Reserve University, Divisionof Maternal Fetal Medicine, Department of Obstetrics and Gynecology,Cleveland, OH, 2MetroHealth Medical Center - Case Western ReserveUniversity, Division of Maternal Fetal Medicine, Departmentof Obstetrics and Gynecology, Cleveland, OHOBJECTIVE: To compare the risk of stillbirth (SB) in ongoing pregnan-cies to the neonatal death rate in the late preterm and early termperiod for low risk and high risk subjects.STUDY DESIGN: Data collected from the Consortium on Safe Labor wasused with multiple gestations, intrapartum SB and deliveries prior to34 weeks gestation excluded. The risk of SB was calculated at eachgestational age (GA) as: number of SB that occurred at a GA/(totaldelivered at GA � all undelivered). Patients with no preexisting med-ical disorders (Lowrisk) served as a reference group. The risk of SB forcontinuing pregnancy in Lowrisk patients was compared to thosewith growth restriction (�5%-tile for birth weight), pre-preg-nancy diabetes (DM), pre-pregnancy hypertension (CHTN) or both(CHTN�DM). Neonatal death rate (ND) was calculated at each GA

for the entire cohort. Log-rank comparisons were used to comparestillbirth risk between groups.RESULTS: 215738 deliveries were included with 396 SB and 223 ND.Comparison of survival curves noted an increased risk of stillbirth (allp�0.05) for each high risk condition when compared to Lowrisk sub-jects. The risk of SB and the rate of ND at each GA for the entirecohort, in addition to the risk of SB for each high risk condition, arepresented in Figure 1. We observed that the risk of SB exceeded therate of ND for those �5%-tile and for pregnancies complicated byCHTN�DM by 37 weeks gestation. Similar observations were madefor those with CHTN or DM at 38 weeks gestation.CONCLUSION: In pregnancies complicated by the conditions above, therisk of remaining undelivered should be considered when determin-ing the optimal time for delivery.

579 Long-term outcomes of children with congenitalgastroschisis: a regional cohortJan E. Dickinson1, Emma Harris2, Susannah Hart1, YvetteWilliams3, Teresa M. Warner4, Liz Nathan5, Corrado Minutillo6

1The University of Western Australia, School of Women’s and Infants’Health, Perth, Australia, 2King Edward Memorial Hospital, NeonatologyClinical Care Unit, Perth, Australia, 3Princess Margaret Hospital, ClinicalPsychology, Perth, Australia, 4King Edward Memorial Hospital, FetalMedicine Service, Perth, Australia, 5Women and Infants ResearchFoundation, Biostatistics and Study Design Unit, Perth, Australia, 6PrincessMargaret Hospital for Children, Neonatal paediatrics, Perth, AustraliaOBJECTIVE: The aim of this study is to assess the physical and develop-mental outcomes of children born with gastroschisis.STUDY DESIGN: Liveborn children with gastroschisis in Western Aus-tralia born between 1992-2005 were identified from the statewide an-tenatal and neonatal databases. Families were contacted and asked toparticipate in the long term outcome assessment study. Children en-rolled in the study were assessed with a health questionnaire, physicalassessment, bone density and nutritional blood values. Developmen-tal outcomes were assessed with WISC (IV) or WIPPSI (III). TheWilcoxon Signed Rank test was utilized to conduct data analysis.RESULTS: In the study time period 110 antenatal cases of gastroschisisoccurred of which 89 could be identified and were able to be con-tacted. Forty-seven children were recruited to participate in the study.The median age was 11.5 years. General health was mainly good al-though over half the children had on going abdominal pain. Weightcentiles had significantly increased from birth to the time of assess-ment (median 51 (IQR 13-66) vs 56 (30-88), p�0.028). The medianheight percentile at assessment was 59 (IQR 21-78.5) and mediansystolic and diastolic blood pressure centiles were 48 (IQR 40-67) and46 (IQR 41-62) respectively. Psychometric testing was performed in39 children. The mean IQ was 98.2 � 10.8. The median fasting glucoseand cholesterol were higher than the population medians, 4.5 vs 4.2mmol/L, p�0.001 and 4.4 vs 3.65 mmol/L, p�0.003 respectively.CONCLUSION: The general health on follow up of children born withgastroschisis was mainly good. Weight, height and blood pressure

www.AJOG.org Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health PosterSessionIV

Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology S263

were within the normal range. Long term development outcomeswere also within normal range. The Barker hypothesis of long termeffects of adverse intrauterine environment on metabolic parametersmay be responsible for higher than expected fasting glucose and cho-lesterol levels.

580 A race-stratified analysis of the risk of intrauterinefetal demise within small for gestational age deliveriesJonathan M. Snowden1, Yvonne W. Cheng2, AmyE. Doss1, Rachel Pilliod3, Aaron B. Caughey4

1Oregon Health and Science University, Department of Obstetrics &Gynecology, Portland, OR, 2University of California, San Francisco,Obstetrics & Gynecology, San Francisco, CA, 3Oregon Health &Science University, Department of Obstetrics and Gynecology,Portland, OR, 4Oregon Health and Science University,Department of Obstetrics and Gynecology, Portland, OROBJECTIVE: To assess the risk of intrauterine fetal demise (IUFD) inthe general population and within strata of race/ethnicity, using mul-tiple percentile cutoffs to define small for gestational age (SGA).STUDY DESIGN: This study analyzed the retrospective cohort of all sin-gleton births in the US in 2005, as recorded in the National Center forHealth Statistics natality database. Using the entire population of 2005births without congenital anomalies as the reference, we generatedthree sets of SGA thresholds based on percentiles of birthweight forgestational age: the 10th percentile (as SGA is commonly defined), the5th percentile, and the 3rd percentile. We then calculated the risk ofIUFD within each of the SGA categories for each term week of gesta-tional age (37 41), using the number of at-risk SGA fetuses as thedenominator. This pool of at-risk fetuses was calculated by summingthe number of SGA births in the index week and in all subsequentweeks.RESULTS: Unsurprisingly, the risk of IUFD increased with lower per-centile thresholds of SGA; for the 3rd birthweight percentile, risksreached 40 60 IUFDs per 10,000 at-risk fetuses in most racial groups.Risks increased with each passing week of gestation, owing to thediminishing pool of at-risk SGA fetuses at each subsequent week.Births to black women exhibited elevated risk at many gestationalages, but the most striking racial difference was the exceptionally lowIUFD risk among SGA Asian births. The risk among Asians rarelyexceeded 1/1,000 at-risk fetuses, and was in many cases less than halfof the risk in other racial groups at the same week of gestation, thoughsmall cell sizes for Asian births resulted in large variability aroundthese estimates.CONCLUSION: These findings call attention to racial differences in riskassociated with SGA. In Asians in particular, SGA appears to be lesspathological and less predictive of IUFD. Future research should ex-amine different outcomes and attempt to identify the range of healthygestational-age-specific birthweights applying to the Asian popula-tion.

581 Antibody responses to pandemic and seasonalinfluenza A H1N1 strains during the 2009-2010 influenzaseason: are the responses during pregnancy similar?Barbra M. Fisher1, Janice Scott1, Ronald S. Gibbs2, AnneLynch2, Virginia D. Winn1, Adriana Weinberg3

1University of Colorado School of Medicine, Obstetrics and Gynecology,Aurora, CO, 2University of Colorado School of Medicine, Department ofObstetrics and Gynecology, Aurora, CO, 3University of Colorado School ofMedicine, Departments of Pediatrics, Medicine, and Pathology, Aurora, COOBJECTIVE: The 2009-2010 seasonal influenza vaccination containedvaccine against an A/Brisbane/29-2007 (H1N1)-like virus (seasonalH1N1). During that season, pandemic influenza A H1N1 emergedand it was recommended that pregnant women be administered amonovalent vaccination against this strain. We sought to compare theantibody responses to the pandemic H1N1 and seasonal H1N1 influ-enza vaccines.STUDY DESIGN: During the 2009-2010 influenza season, we enrolled acohort of pregnant women (n�40) who received pandemic H1N1influenza, seasonal H1N1 influenza, both, or neither vaccine. Mater-nal and umbilical cord venous blood samples were collected at deliv-ery. Hemagglutination inhibition assays (HAI) for pandemic and sea-sonal H1N1 were performed for each matched maternal/cord bloodpair. Data were analyzed using correlation and linear regression anal-yses.RESULTS: Fourteen participants were vaccinated against pandemicH1N1 influenza during pregnancy and 28 women were vaccinatedagainst seasonal H1N1 influenza. We found that (1) 6/14 (43%)women vaccinated against pandemic influenza and 17/28 (61%)women vaccinated against seasonal influenza had protective antibodytiters (� 1:40) at delivery, (2) the geometric mean titer for the pan-demic strain was similar to that for the seasonal strain (38 vs 54), (3)there was a similar linear relationship between maternal antibody ti-ters at delivery and cord antibody titers for both pandemic and sea-sonal influenza vaccines, (4) eleven women were vaccinated againstboth H1N1 strains; of the 5 women who did not have an antibody titer� 1:40 against the seasonal vaccine, 4 did not have a titer � 1:40 forthe pandemic vaccination.CONCLUSION: Both pandemic and seasonal H1N1 vaccinations pro-duce similar antibody responses during pregnancy and confer passiveimmunity to the neonate. Further study of influenza vaccination dur-ing pregnancy should advance our understanding of immune re-sponses in pregnancy and aid in the development of novel vaccines.

PosterSessionIV Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health www.AJOG.org

S264 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012