SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 192A

192A

Reproductive Sciences Vol. 25, Supplement 1, March 2018

F-029
Femur-Sparing Pattern of Abnormal Fetal Growth after Possible
Zika Virus Infection. Christie L Walker†,3 Audrey Merriam†,1 Eric
O Ohuma,2 Manjiri K Dighe,3 Michael Gale, Jr.,3 Lakshmi Rajagopal,3
Aris Papageorghiou,2 Cynthia Gyamfi-Bannerman,1 Kristina M Adams
Waldorf*.3 1Columbia University Medical Center, New York City, NY,
United States; 2University of Oxford, Oxford, United Kingdom; 3University
of Washington, Seattle, WA, United States.
INTRODUCTION: Zika virus (ZIKV) is a flavivirus, which can
induce fetal brain injury and growth restriction following infection
during pregnancy. Prenatal diagnosis of ZIKV-associated fetal injury
in the absence of microcephaly is challenging due to an incomplete
understanding of how ZIKV infection affects fetal growth and the use of
different sonographic reference standards. We hypothesized that growth
of the fetal femur is unaffected by ZIKV infection and can represent an
internal standard to aid in the detection of growth deceleration of the fetal
head and/or abdomen by ultrasound. The study objective was to determine
if maternal ZIKV infection was associated with a femur-sparing pattern
of growth restriction.
METHODS: Pregnant women diagnosed with a possible recent ZIKV
infection at Columbia University Medical Center were retrospectively
identified and included if a fetal ultrasound was performed. Data
was collected regarding ZIKV testing, fetal biometry, pregnancy and
neonatal outcomes. INTERGROWTH-21st Project (IG-21) and Hadlock
sonographic standards were applied to obtain Z-scores for fetal biparietal
diameter (BPD), head and abdominal circumference (HC, AC) and femur
length (FL) specific for each gestational week. A novel IG-21 reference
standard was developed to generate Z-scores for fetal body ratios with
respect to FL (BPD:FL, HC:FL, AC:FL). Statistical analysis involved
Wilcoxon signed-rank tests on paired data.
RESULTS: A total of 56 pregnant women were included in the study with
laboratory evidence of a confirmed or possible recent ZIKV infection. IG21 and Hadlock sonographic standards performed similarly for detection
of microcephaly (HC Z-score ≤ -2; 5% by IG-21 and 9% by Hadlock)
and intrauterine growth restriction [AC Z-score ≤ -1.3 (≤10%); 20% by
both IG-21 and Hadlock]. Analysis of fetal growth revealed a significantly
abnormal skewing of fetal biometric Z-scores by IG-21, but not Hadlock,
suggesting decelerating growth of the fetal head and abdomen with
respect to the femur after 28 weeks (e.g. 28-33 6/7 weeks: BPD vs. FL,
p<0.001). In comparison to standard diagnostic criteria for intrauterine
growth restriction (AC ≤10%) met by 21% of fetuses, 72% of fetuses had
evidence of a femur-sparing pattern of growth restriction [Z-score ≤-1.3
(≤10%] through an analysis of IG-21 fetal body ratios [BPD:FL (63%),
HC:FL (35%) or AC:FL (30%)].
CONCLUSION: A femur-sparing pattern of abnormal fetal growth was
detected in the majority of fetuses from pregnancies with congenital
ZIKV exposure using the IG-21 sonographic standard. Fetal body ratios
may be useful to identify aberrant fetal growth and pregnancies at risk
for long-term complications of congenital ZIKV infection.

F-030
Obstetrical and Perinatal Outcomes of Patients with Acute
Methamphetamine Intoxication on Labor and Delivery. Tiffany
Pham†,2 Yolanda Tinajero†,1 Lihong Mo†,2 Mallory Kremer*.2 1UC Davis,
Davis, CA, United States; 2UCSF Fresno, Fresno, CA, United States.
INTRODUCTION: The incidence of hospital encounters associated with
methamphetamine abuse across the United States is increasing. Existing
literature on methamphetamine abuse in pregnancy has yielded conflicting
results. Methamphetamines are detectable in urine drug screens for 72
hours, which presents a unique opportunity to investigate outcomes in
patients acutely intoxicated with methamphetamine compared to those
without amphetamines in their system during their labor and delivery
admission.
METHODS: A single-site retrospective cohort study from January to
December 2015 was performed. Patients who were tested with a urine
drug screen (UDS) during the delivery encounter were identified in the
electronic medical record. Patients with a negative UDS were considered
controls and compared to those with a methamphetamine-positive

Scientific Abstracts

UDS. The primary maternal outcomes of interest were abruption and
hypertensive disorders. Secondary outcomes included preterm birth, birth
weight, Apgar scores, and neonatal demise.
RESULTS: A cohort of 47 patients with a methamphetamine positive
UDS were compared to 74 patients with a negative UDS admitted for labor
and delivery. Acute methamphetamine intoxication carries an increased
risk of abruption (OR 7.4, CI 1.5-36.5) but not maternal hypertensive
disorders. Methamphetamine use was associated with poor perinatal
outcomes: increased risk of preterm birth (OR 4.1 CI 1.9-9.1), lower
birth weight (p=0.05), lower Apgar at 5 minutes (p=0.002), and increased
perinatal mortality (OR 15.0, CI 1.8-124.1).
CONCLUSION: Acute methamphetamine intoxication on labor and
delivery confers significant perinatal morbidity and mortality. With the
exception of abruption, amphetamines did not greatly impact maternal
delivery outcomes.
*Figure(s) will be available online.

F-031
Daily Opioid Dose in Mothers with Sickle Cell Anemia is Not
Predictive of Treatment for Neonatal Abstinence Syndrome. Chelsea
DeBolt†,2 Courtney Townsel†,2 Erica Hammer*,1 Biree Andemariam*,2
Naveed Hussain*,2 Anne-Marie Prabulos*.2 1Hartford Hospital, Hartford,
CT, United States; 2University of Connecticut, Farmington, CT, United
States.
INTRODUCTION: Opioids are the mainstay of treatment for pain crises
in sickle cell disease (SCD). Pregnant mothers with SCD on opioids risk
delivering infants who might develop neonatal abstinence syndrome
(NAS). We hypothesize that daily maternal opioid dose in SCD mothers
is not predictive of NAS treatment.
METHODS: We undertook a retrospective cohort study of all SCD
mothers maintained on chronic opioid pain therapy who delivered at our
tertiary hospital from January 2005 to April 2017. Primary outcome was
treatment for NAS. Treatment occurred with 3 consecutive Finnegan
scores greater than or equal to 8 or 3 scores totaling greater than or equal
to 24 within the first 96 hours or life. Factors evaluated include: maternal
age, gestational age at delivery, maternal daily morphine equivalent dose
(mg/day), peak and time to peak Finnegan score, neonatal length of stay.
Data analysis was by Wilcoxon rank-sum test and Fisher's exact test. All
tests were two-sided with alpha of 0.05.
RESULTS: 16 SCD pregnant mothers and 20 infants were identified. NAS
was diagnosed in 80% (n=16) of neonates. NAS treatment was required in
60% (n=12) of neonates. Neonatal length of stay was significantly longer
in infants treated for NAS versus infants not treated [25.3 days vs 13.2
days, p=0.003]. Mean peak Finnegan scores were significantly higher in
infants treated for NAS versus infants not treated [12.91 vs. 3.75, p<0.001].
Daily maternal opioid dose was higher for NAS treated infants verses
infants not treated, however this difference was not significant [712.33
mg/day vs 309.75 mg/day, p=0.098].
CONCLUSION: Daily maternal opioid dose in pregnant SCD patients
does not predict the need for NAS treatment. There may be non-dose
dependent factors that influence the need for NAS treatment. The
pharmacokinetics of opioid exposure in-utero requires further exploration.
*Figure(s) will be available online.

F-032
Evaluation of an Introduction of a Protocol for Antenatal Late
Preterm Steroids in a High Volume Maternity Center. Nevert
Badreldin†, Grace Willert†, Alan Peaceman, Leslie Caldarelli, Lynn
Yee. Northwestern University Feinberg School of Medicine, Chicago,
IL, United States.
INTRODUCTION: Our objective was to evaluate neonatal outcomes
associated with implementation of a protocol for administration of
antenatal late preterm steroids compared to a historic cohort.
METHODS: This is a retrospective cohort study of all women with
singleton pregnancies who were admitted between 34 0/7-36 6/7 weeks
in periods before (preprotocol; 11/2012-13) and after (postprotocol;
4/2016-17) introduction of an antenatal late preterm steroids protocol.
Analysis was restricted to women who received care adherent to the



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

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SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - Cover3
SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - Cover4
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2020
https://www.nxtbook.com/nxtbooks/sage/psychologicalscience_demo
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2020
https://www.nxtbook.com/nxtbooks/sage/fai_202009
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_august2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2019
https://www.nxtbook.com/nxtbooks/sage/fai_201909
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_july2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2019
https://www.nxtbook.com/nxtbooks/sage/canadianpharmacistsjournal_05062019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2019
https://www.nxtbook.com/nxtbooks/sage/sri_supplement_201903
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2018
https://www.nxtbook.com/nxtbooks/sage/tec_20180810
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2018
https://www.nxtbook.com/nxtbooks/sage/fai_201807
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2018
https://www.nxtbook.com/nxtbooks/sage/sri_supplement_201803
https://www.nxtbook.com/nxtbooks/sage/slas_discovery_201712
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_november2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_september2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2017
https://www.nxtbook.com/nxtbooks/sage/fai_supplement_201709
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_may2017
https://www.nxtbook.com/nxtbooks/sage/fai_201706
https://www.nxtbook.com/nxtbooks/sage/fai_201607
https://www.nxtbookmedia.com