spectively. However, the expression of CRF-BP was higher in responseto perfusion with MgSO4 than in response to perfusion with LPS,mean RQ of 0.78 � 0.35 vs. 0.16 �0.04, respectively.CONCLUSION: In the human perfused placenta, MgSO4 and LPS stim-ulate inversely on the expression of CRF and CRF-BP, suggesting aunique protection mechanism in response to inflammatory stimuli.

676 Obesity and adverse pregnancyoutcomes in twin pregnanciesNathan Fox1, Ashley Roman4, Daniel Saltzman2, Chad Klauser3,Andrei Rebarber3

1Mount Sinai School of Medicine, Obstetrics, Gynecology and ReproductiveScience, New York, NY, 2Carnegie Imaging for Women, PLLC, Obstetricsand Gynecology, New York, NY, 3Maternal Fetal Medicine Associates, PLLC,Obstetrics and Gynecology, New York, NY, 4NYU School of Medicine,Obstetrics and Gynecology, New York, NYOBJECTIVE: Maternal weight abnormalities such as prepregnancy obe-sity and underweight have been associated with numerous adversepregnancy outcomes in singleton pregnancies. Our objective was tocompare pregnancy outcomes based on maternal prepregnancy bodymass index (BMI) in twin pregnancies.STUDY DESIGN: Cohort study of all twin pregnancies �24 weeks man-aged by one maternal-fetal medicine practice from 2005-2012. Mono-amniotic twins and twins with TTTS were excluded. We comparedpregnancy outcomes between women with a normal prepregnancyBMI (18.5 - 24.99 kg/m2) and women with prepregnancy under-weight (�18.5 kg/m2), overweight (25-29.99 kg/m2), and obese (�30kg/m2) BMI. Outcomes measured were gestational age at delivery,cesarean delivery, low birthweight (�2500g of either twin), birth-weight, any gestational hypertension, preeclampsia, gestational dia-betes, and IUFD. Chi square, Fisher’s exact test, and Student’s t-testwere used. A p-value of �0.05 was considered significant.RESULTS: 514 twins were included. 30 (5.8%) were underweight, 343(66.7%) normal weight, 95 (18.5%) overweight, and 46 (8.9%) obese.Prepregnancy obesity was associated with gestational hypertension,preeclampsia, and gestational diabetes, but also with larger birth-weights and a reduced incidence of low birthweight (Table). Prepreg-nancy overweight was not associated with any adverse pregnancy out-comes, aside from gestational diabetes (13.7% vs. 4.7%, p�0.002).Prepregnancy underweight was not associated with any adverse preg-nancy outcomes.CONCLUSION: In patients with twin pregnancy, prepregnancy obesity isassociated with adverse pregnancy outcomes, including gestationaldiabetes, gestational hypertension, and preeclampsia, as well as largerbirthweights.

677 Anemia during pregnancy as a marker for long termmaternal cardiovascular morbidity: a decade of follow upRoy Kessous1, Gali Pariente1, Ilana Shoham-Vardi2, Eyal Sheiner1

1Soroka University Medical Center, Ben-Gurion University of the Negev,Department of Obstetrics and Gynecology, Faculty of Health Sciences, Beer-Sheva, Israel, 2Ben-Gurion University of the Negev, Epidemiology andHealth Services Evaluation, Beer-Sheva, IsraelOBJECTIVE: To investigate whether a diagnosis of anemia during preg-nancy is a risk factor for subsequent long-term cardiovascular mor-bidity, in a follow-up period of more than a decade.STUDY DESIGN: A population-based study comparing long-term car-diovascular complications of consecutive pregnancies of women withand without a diagnosis of anemia during pregnancy (defined as he-moglobin level� 10 gr/dL) was conducted. Deliveries occurred dur-ing the years 1988-1999 and had a follow up period (for cardiovas-cular morbidity) until 2010. Incidence of long-term cardiovascularhospitalizations and morbidity was compared between womenwith anemia and women who gave birth at the same period with noanemia. Multiple logistic regression models were constructed tocontrol for confounders.RESULTS: During the study period there were 47909 deliveries whomet the inclusion criteria, 12,362 (25.8%) occurred in patients whowere diagnosed with anemia during pregnancy. No significant differ-ences were noted regarding subsequent long term non-invasive andinvasive cardiovascular procedures. Nevertheless, patients with ane-mia had significantly higher rates of complex cardiovascular events,such as congestive heart failure, cardiac arrest etc. (OR�1.7, 95% CI1-2.8, P�0.042; table). In a multivariate logistic regression model,controlling for confounders such as maternal age and ethnicity, ane-mia during pregnancy was noted as an independent risk factor forlong-term cardiovascular hospitalizations (adjusted OR� 1.3; 95%CI-1.1-1.4, P � 0.001).CONCLUSION: Anemia during pregnancy is associated with an in-creased risk for long-term cardiovascular morbidity in a follow-upperiod of more than a decade.

678 Severe sleep disruption and neonatal birthweightShannon Ho1, Anna Shaw2, Judette Louis3

1Boonshoft School of Medicine, Wright State University, Division ofMaternal Fetal Medicine, Department of Obstetrics & Gynecology, Dayton,OH, 2MetroHealth–Case Western Reserve University, Division of MaternalFetal Medicine, Department of Obstetrics & Gynecology, Cleveland, OH,3Morsani College of Medicine, University of South Florida, Division ofMaternal Fetal Medicine, Department of Obstetrics & Gynecology, Tampa,FLOBJECTIVE: Prior studies have reported a decrease in fetal growth as-sociated with sleep disruption. We sought to evaluate the effect ofsevere sleep disruption on neonatal birthweight.STUDY DESIGN: A prospective cohort study was performed. Womenwith term pregnancies completed validated sleep questionnaires as-sessing hypersomnolence and symptoms of sleep disordered breath-ing (Epworth Sleepiness Scale and Berlin Sleep Questionnaire). Severesleep disturbance (SSD) was defined as �5 hours per night of sleepalong with an abnormal sleep survey. After delivery neonates under-went anthropometric measurements within 72 hours of birth. Statis-tical analysis was performed using chi square, Student t-test for nor-mal distribution and Wilcoxon test for non-parametric distribution;Forward stepwise regression was performed to control for factors thataffected birthweight and ponderal index. P�0.05 was considered sig-nificant.

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Supplement to JANUARY 2013 American Journal of Obstetrics & Gynecology S285