657: severity of maternal obesity impacts the incidence of adverse pregnancy outcomes in high-risk...

656 INFECTION, HIV/AIDS AND MATERNAL DEATH: A POPULATION-BASED STUDY INRURAL HAITI SUSAN MARTINSON1, HENRY PERRY2, RIKERDY FREDERIC3, JOANNEPREVAL4, MARIA SMALL5, 1Cambridge Health Alliance, , Massachusetts, 2Future Gen-erations, Franklin, West Virginia, 3Hopital Albert Schweitzer, Community Health,Obstetrics and Gynecology, Port Au Prince, Haiti, 4University of Montreal, BritishColumbia, Canada, 5Duke University, Durham, North Carolina

OBJECTIVE: To assess the prevalence and causes of maternal mortality in apopulation-based study of women of reproductive age in rural Haiti. The pupose ofthe work was to evaluate maternal outcomes in women living in an area with adeveloped community health program. The prevalence of HV infecton amongpregnant women at the time of the study was 3.9%.

STUDY DESIGN: The population of 148,000 individuals in the rural ArtiboniteValley was canvased to identify women of reproductive age (15-49) who died overa 6 year period. Of the 706 deaths identified, a random sample of 99 women wasselected. Key family members were identified and interviewed by trained researchassistants. Eighteen of the deaths were identified as maternal mortalities. Availablemedical records were reviewed to independently validate interview-assigned diag-noses.

RESULTS: The maternal mortality ratio was 529 deaths per 100,000 live births(95% CI 313.0-836.0) Sepsis (excluding HIV/AIDS) accounted for 44.4% of deaths(95% CI 21.52-69.2), eclampsia was responsible for 33% (95% CI 13.3-59.0) andHIVAIDS for 11% (95% CI 1.4-34.7) of maternal deaths. Hemorrhage accountedfor 5.6% of maternal deaths. Of the 33% of deaths occuring in the hospital, allinterview-assigned diagnoses matched clinically- determined causes of death.

CONCLUSION: Hospital--based studies identify preeclampsia/eclampsia as theleading cause of maternal death. Sepsis, however, including HIV/AIDS was theleading cause of maternal death in this community--based study, highlighting theneed for improved community-based antimicrobial and antiretroviral therapy formaternal mortality prevention.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.683

657 SEVERITY OF MATERNAL OBESITY IMPACTS THE INCIDENCE OF ADVERSEPREGNANCY OUTCOMES IN HIGH-RISK TERM PREGNANCIES SAJU JOY1, NIKIISTWAN2, DEBBIE RHEA2, GARY STANZIANO2, 1Wake Forest University, Winston-Sa-lem, North Carolina, 2Matria Healthcare, Clinical Research, Marietta, Georgia

OBJECTIVE: Obesity is recognized as a public health concern of epidemic pro-portions. There are limited data revealing maternal and fetal outcomes in the obesegravida. The purpose of this study was to investigate if pregnancy outcomes differby the level of maternal obesity.

STUDY DESIGN: Women with normal or obese BMI that delivered singletoninfants at term were identified from a database comprised of information collectedfrom women who received outpatient nursing services for various conditions dur-ing pregnancy. Maternal characteristics, rates of pregnancy complications and neo-natal outcomes were compared between women with normal pre-pregnancy BMI(20-24.9 kg/m2, n�9,171) and those with an obese pre-pregnancy BMI (�30-34.9kg/m2, n�2,106), severe obesity (35-39.9 kg/m2, n�953), and morbid obesity(�40 kg/m2, n�685) and between each advancing BMI group.

RESULTS: Maternal characteristics (smoking, African-American race, maritalstatus and parity) did not differ among obese BMI groups. Maternal and neonataloutcomes for stratified BMI groups are presented in table. 1�p-value �0.05 vs.Normal BMI group; 2 � vs. BMI 30-34.9; 3 �vs.35-39.9 (adjusted for multiplecomparisons).

Normal BMI(n�9171)

BMI 30–34.9(n�2106)

BMI 35–39.9(n�953)

BMI �40(n�685) p-value

GestationalDiabetes

3.7% 9.6%1 14.1%1,2 16.4%1,2 �0.001

GestationalHypertension

9.0% 25.5%1 33.7%1,2 43.4%1,2,3 �0.001

InterventionalDelivery

36.0% 50.4%1 58.6%1,2 60.0%1,2 �0.001

Birth Weight�4000gms

4.8% 8.6%1 12.0%1 9.6%1 �0.001

Birth Weight�4500gms

0.6% 1.6%1 2.3%1 1.6%1 �0.001

CONCLUSION: An obese BMI places a pregnancy at risk for adverse maternaland neonatal outcomes. The level of obesity affects the risk for interventional de-livery and development of gestational diabetes and especially gestational hyperten-sion.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.684

658 LATENCY AND INFECTIOUS COMPLICATIONS FOLLOWING PRETERM PREMATURERUPTURE OF THE MEMBRANES: IMPACT OF BODY MASS INDEX. SAJU JOY1, 1NICHDMFMU Network, Bethesda, Maryland

OBJECTIVE: Obesity has been associated with chronic inflammation. We hy-pothesized that body mass index (BMI) may be inversely related to latency (timefrom rupture to delivery) and directly related to infectious complications followingpreterm premature rupture of the fetal membranes (pPROM).

STUDY DESIGN: This is a secondary analysis of a randomized trial of antibioticsfor pPROM. Complete information was available for 591 of 614 subjects. We ana-lyzed the association between BMI (underweight n � 87, normal n � 304, over-weight n � 116, obese n� 73, morbidly obese n � 11) and latency, the occurrenceof chorioamnionitis, endometritis and any maternal infectious morbidity, aftercontrolling for gestational age (GA) at rupture and treatment group. Survival anal-ysis, ANOVA, regression and test of proportions were used as appropriate.

RESULTS: Latency to delivery was affected by gestational age at randomizationand antibiotic therapy, but not by BMI group (Table 1). There was no difference inthe mean latency among the 5 categories of BMI (Table 2) (stratified by treatmentgroup, p � 0.95 for active treatment and 0.24 for placebo). When evaluated as acategorical or continuous variable, BMI was not significantly associated with cho-rioamnionitis, endometritis or any postpartum infectious morbidity.

CONCLUSION: BMI does not affect latency or the occurrence of maternal infec-tious complications during conservative management of PROM before 32 weeksgestation.

Latency to delivery

Variable P value Hazard ratio

Treatment Group 0.0112 0.810GA at ROM �0.0001 1.013BMI 0.5129 1.005

Latency stratified by BMI

BMI category N Mean (days) Standard deviation

Underweight 87 11 15Normal 304 9 14Overweight 116 11 15Obese 73 10 18Morbidly obese 11 8 8

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.685

659 ADVERSE PERINATAL OUTCOMES: A NEW APPROACH TO THE ROLE OF THEPLACENTA? HELEN M. MC NAMARA1, ROBERT W. PLATT2, ALICE BENJAMIN3,MICHAEL S. KRAMER2, 1McGill University, Obstetrics & Gynecology, Epidemiology& Biostatistics, Montreal, Quebec, Canada, 2McGill University, Pediatrics, Epide-miology & Biostatistics, Montreal, Quebec, Canada, 3Royal Victoria Hospital, Ob-stetrics & Gynecology, Montreal, Quebec, Canada

OBJECTIVE: The role of the placenta in adverse perinatal outcomes is unclear.We have developed a new approach, using placental weight for gestational agez-score (PZG). We have shown that PZG is an independent risk factor for adverseperinatal outcomes, exerting opposite effects to birthweight in neonatal outcomes.In order to clarify the nature of this association, we wished to examine the deter-minants of PZG.

STUDY DESIGN: We performed a hospital-based cohort study of 71,219 single-ton deliveries in 1978-2000 without congenital anomalies. We analyzed the inde-pendent contributions of maternal and fetal factors on the outcome PZG. Datawere analyzed using multiple linear regression, controlling for gestational age &birthweight for gestational age z-score (BZG).

RESULTS: After adjusting for BZG, the following risk factors were significantlyassociated with an increase in PZG: smoking 0.152 SD [95%CI 0.130, 0.174]; ane-mia 0.128 SD [95%CI 0.094, 0.163]; diabetes 0.087 SD [95%CI 0.052, 0.122]; femalegender 0.063 SD [95%CI 0.046, 0.080]; parity 0.039 SD [95%CI 0.021, 0.057]; andpre-pregnancy BMI 0.024 SD [95%CI 0.020, 0.027]. Hypertension was inverselyassociated with PZG (�0.038 SD [95%CI �0.069, �0.007]), as was maternal age(�0.002 SD [95%CI �0.004, �0.00006]). Maternal height was not significantlyassociated with PZG.

CONCLUSION: Our results suggest that smoking, anemia, and diabetes may bethe main risk factors for increased PZG, (which is independently associated withincreased adverse neonatal outcomes). This is in addition to the adverse effects ofsmoking and diabetes on birthweight. It is important to consider the possible dualeffect of these risk factors in future studies, especially those examining the potentialvalue of PZG in clinical practice, with a view to further improving our predictionand prevention of adverse perinatal outcomes.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.686

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