SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 129A

Scientific Abstracts

T-059
Prevalence of Vulnerability and the Association with Perinatal
Outcome in a Population Sample of Pregnant Women in the
Netherlands. Marjolein W de Groot†, Johanna P de Graaf*, Eric AP
Steegers*, Loes CM Bertens*. Erasmus University Medical Center,
Rotterdam, Netherlands.
INTRODUCTION: It is a common believe that vulnerability leads to
poor perinatal outcome. Vulnerability is a complex concept with varying
definitions and can be described as multifactorial, to which both individual
and contextual factors can contribute. The prevalence of vulnerability
is still unclear. In this study we looked at individual risk factors of
vulnerability and the availability of personal and social resources to cope
with these individual risk factors. We hypothesized that individual risk
factors like psychopathology, psychosocial problems or substance use
enlarges risk of adverse perinatal outcome.
METHODS: Patients of 45 midwifery practices and 6 obstetric units
in the south-west of the Netherlands were invited to participate in this
prospective cohort study during their first antenatal visit. Degree of
vulnerability was determined by structured screening via a self-reported
questionnaire. Presence of psychopathology, psychosocial problems or
substance use was considered as a risk factor of vulnerability. Vulnerability
was defined as a combination of at least one of these risk factors and a
lack of resources. Adverse perinatal outcome was operationalized as
perinatal mortality (death between 22 weeks of gestational age and 7
days after birth) and perinatal morbidity (defined as preterm birth and/or
small for gestational age).
RESULTS: 3197 patients filled out the questionnaire. A total of 16.7%
was categorized as being vulnerable and 41% had one or more risk
factors for vulnerability. Of the risk factors contributing to vulnerability,
substance use was the most frequently reported (25.8%), while
psychosocial problems were most often reported in combination with a
lack of resources. Both vulnerable pregnant women and women at risk
had overall more unfavorable perinatal outcomes compared to those not at
risk or not vulnerable, with a significant difference for perinatal morbidity
(OR vulnerable women 1.63, 95% CI 1.03-2.59; and OR women at risk
1.46, 95% CI 1.02-2.09).

129A

CONCLUSION: A considerable proportion of pregnant women was
defined as being vulnerable and this was associated with more adverse
perinatal outcomes. Efforts should be made to detect vulnerability timely
in order to increase chances improving perinatal health.

T-060
Zika Virus (ZIKV) Infection during the First, Second and Third
Trimesters in the Pregnant Olive Baboon. Sunam Gurung†, Krista
Singleton, Ashley Martin†, Jamie Dubaut†, Alisha Preno, James Papin,
Dean Myers*. University of Oklahoma HSC, Oklahoma City, OK, United
States.
INTRODUCTION: Maternal ZIKV infection is associated with
pregnancy loss, fetal microcephaly and other malformations. It is critical
to establish non-human primate (NHP) models that recapitulate human
ZIKV pathogenesis, mechanism of action and tissue tropism. The olive
baboon (Papio anubis) is similar to humans in terms of genetics, size,
brain development, placentation and immune system, making this NHP
an excellent translational model for ZIKV infection and pathogenesis.
The stage of pregnancy at the time of ZIKV infection likely plays a
significant role in vertical transfer, fetal CNS outcome and severity of
fetal pathology. We hypothesized that 1st and 2nd trimesters (trim) would
be most vulnerable for vertical ZIKV transmission in the olive baboon.
METHODS: Timed pregnant female baboons were infected
subcutaneously with ZIKV (104 ffu; French Polynesian isolate:H/PF/2013)
during the 1st (64-72d gestation, dG; n=3), 2nd (109-121dG; n=4) and 3rd
trim (153-168dG; n=5). Blood samples were collected under anesthesia on
0,4,14,21d post-infection (dpi;1st), 0,3,7,14,21dpi (2nd) and 0,2,7,14,21dpi
(3rd). For each cohort, at least one animal was euthanized at 7, 14 or 21dpi
and maternal/fetal tissues collected. vRNA was extracted from tissues/
fluids and quantified by qRT-PCR.
RESULTS: All baboons exhibited clinical symptoms of rash with or
without conjunctivitis following ZIKV inoculation. Intrauterine death
occurred for one fetus in each trim; the 3rd trim ZIKV cohort had one
preterm live birth. All dams exhibited ZIKV RNA in either blood (10/12),
or tissues (12/12;Table 1). ZIKV was detected in placenta of two 1st, one
2nd and no 3rd trimester pregnancies. ZIKV RNA was detected in one 2nd
trim fetus (CNS; 21 dpi) and one 1st trim fetus (cord). (FM: female; Blood
(ZIKV copies/ml); Plac (Placenta), Uterus, Fetal CNS (ZIKV copies/mg);
BLD (below limit of detection); FD (Fetal Death); PTB (Preterm Birth)
CONCLUSION: Olive baboons exhibited classical physical symptoms
with evidence of vertical transmission to fetal CNS in 2nd trim fetus.
Although fetal CNS infection was not seen in the 1st trim cohort, one
baboon at 14dpi showed infection in placenta, fetal membranes and
umbilical cord supporting vertical transfer to fetus. Notably, placental
infection was routinely seen in 1st and 2nd but not 3rd trimesters. Fetal death
and/or preterm birth is consistent with human ZIKV infection. Support:
NIH NS103772, OD010988
TABLE 1
ID

End (dpi)

Blood

Plac.

Uterus

FetalCNS

Tri 1 FM1

6

4.9x105

5.2x104

BLD

FD

Tri 1 FM2

14

BLD

4.5x104

1.5x104

BLD

Tri 1FM3

21

1.2x104

BLD

BLD

BLD

Tri 2FM1

7

8.5x103

BLD

BLD

BLD

Tri 2FM2

14

4.9x106

BLD

8.4x103

FD

Tri 2FM3

14

2.2x106

BLD

BLD

BLD

Tri 2 FM4

21

9.4x105

1.3x104

BLD

2.9x104

Tri 3FM1

7

3.9x104

BLD

7.9x107

FD

Tri 3FM2

7

4.7x104

BLD

BLD

BLD

Tri 3FM3

12

BLD

NA

2.6x104

PTB

Tri 3FM4

14

6.4x104

BLD

BLD

BLD

Tri 3FM5

21

4.6x104

BLD

BLD

BLD

Thursday Posters

was composite neonatal morbidity: need for respiratory support, culture
positive sepsis, antibiotics >72h and neonatal death. Secondary outcomes
included: NICU admission, length of NICU stay, maternal and neonatal
complications.
RESULTS: A total of 189 mother-infant dyads met criteria, 118 with EM
and 71 with ID. The median gestational age of PPROM was 33w6d (range
22w6d-34w6d) and the median gestational age at delivery was 34w4d
(range 34w0d-35w3d). Median latency was 5 d (IQR 1.0-12.5d). There
was no association between PPROM delivery practice and composite
neonatal outcome (aRR 0.69 (95% CI 0.27-1.78), p=0.44). There was
also no difference in NICU admission rate (RR 0.57 (95% CI 0.23-1.37),
p=0.52), although infants with EM had a significantly shorter length
of NICU stay (6 days vs 10 days, p<0.001). There was no association
between EM and need for respiratory support, ventilation, or oxygen
therapy. Finally, there was a higher rate of placental chorioamnionitis
and endometritis with EM compared to ID (40.2% vs 17.1%, p=0.001
and 1.7% vs 0%, p=0.046, respectively) but no significant difference in
clinical chorioamnionitis (16.5% vs 8.5%, p=0.13). There were no cases
of neonatal or maternal sepsis.
CONCLUSION: Overall, there was no association between EM and
composite neonatal morbidity and EM was associated with a decrease in
the length of NICU admission. Interestingly, neonatal need for respiratory
support, ventilation, or oxygen therapy was not different between EM
and ID. Although pathologic chorioamnionitis and endometritis rates
were higher with a policy of EM, severe adverse outcomes like clinical
chorioamnionitis were not different and sepsis did not occur. This study
provides information on maternal and neonatal outcomes with EM of
preterm PPROM after 34 weeks.

Reproductive Sciences Vol. 25, Supplement 1, March 2018
Table of Contents for the Digital Edition of SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018
