SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 270A

270A

Reproductive Sciences Vol. 25, Supplement 1, March 2018

S-051
Association between Sonographic Estimated Fetal Weight and the
Risk of Cesarean Delivery among Nulliparous Obese Women . Annie
Dude†, Berkley Davis†, Katie Delaney†, Lynn M Yee*. Northwestern
University, Chicago, IL, United States.
INTRODUCTION: Prior work assessing the relationship between third
trimester ultrasound estimate of fetal weight (US-EFW) and cesarean
delivery (CD) risk has focused on low risk women. Obese women are at
higher risk of CD than their counterparts. Our aim was to examine the
association between having an US-EFW as well as a predicted large-forgestational-age (LGA) US-EFW and mode of delivery among nulliparous
obese women.
METHODS: This is a retrospective cohort of nulliparous women with
a BMI of 35 kg/m2 or greater at delivery who delivered term, singleton
gestations at a single academic institution (2010-15). Clinical and
demographic data were abstracted to determine 1) whether having had
an US-EFW within 5 weeks of delivery was associated with any CD and
with CD for arrest of dilation, descent, or failed induction of labor (arrest
disorder, AD) and 2) among those with a recent US-EFW, whether an LGA
diagnosis was associated with any CD and with CD for an AD. Bivariable
analyses and multivariable logistic regression were used as appropriate.
RESULTS: Of 1,206 women who met eligibility criteria, 299 (24.8%)
had an US-EFW within 5 weeks of delivery. Women who had an US-EFW
were younger, had greater BMI, and were more likely to have any type of
diabetes, but were not different in terms of ultimate birthweight. Having
a recent US-EFW was associated with increased frequency of any CD
(47.8% vs. 36.9%, p = 0.001); this finding persisted even when controlling
for birthweight and other confounding factors (aOR 1.47, 95% CI 1.101.98) (Table). Among those with a recent US-EFW, diagnosis of LGA
was associated with any CD (68.1% vs. 41.7%, p < 0.001) and with CD
for an arrest disorder (52.2% vs. 26.1%, p< 0.001), but in multivariable
models that accounted for birthweight and other potential confounding
factors, only the relationship with any CD persisted (aOR 2.10, 95%CI
1.03-4.29) (Table).
CONCLUSION: The performance of an US-EFW among nulliparous
obese women was associated with an increased risk of CD. Moreover, an
ultrasound diagnosis of LGA was associated with an increased risk of CD.
*Figure(s) will be available online.

S-052
Lysosomal Transcription Factor EB (TFEB) in Normal and
Gestational Diabetes Mellitus Complicated Pregnancy: A Pilot Study
Supporting the Placental Role in Pregnancy Metabolic Adaptation.
Karen Kochan†, Itay Hasson†, Gheona Altarescu, Rivka Farkash, Yair
Herskovitz†, Tzvia Rosen†, Orit Barenholz-Goultschin, Arnon Samueloff,
Sorina Grisaru-Granovsky*. Shaare Zedek Medical Center, Jerusalem,
Israel.
INTRODUCTION: Lysosome- autophagy has a central role in nutrient
sensing and adaptation to pregnancy induced metabolic requirements.
TFEB is a major lysosme regulator gene. Our aim was to examine the
expression of TFEB in peripheral blood of women in late gestation, with
and without gestational diabetes mellitus (GDM) and their neonates.
METHODS: Single center, prospective case-control pilot study, between
2015-2016. Maternal and neonatal (umbilical cord) paired blood samples,
from pregnanacies with term singleton live fetus, with and without GDM
were obtained at delivery. Real time RT PCR was used to identify the
TFEB level of expression.
RESULTS: Forty three parturients were enrolled: 22 non-GDM and 21
GDM; maternal and neonatal characteristics were comparable. Among
the GDM: 76% had a controlled glycemia; 57.1% with diet alone. TFEB
level of expression for the GDM vs non GDM, for either the mothers or
neonates were similar (p= 0.776 and p = 0.26, respectively). GDM TFEB
mean maternal-neonatal difference was wider than for the non- GDM;
the major contributor was the higher maternal mean level, possibly
placental. Maternal TFEB expression significantly correlated to first
trimester maternal BMI p = 0.050. TFEB expression did not correlate
with neonatal birth weight; the mean TFEB was higher for the females
as compared to male newborns.

Scientific Abstracts

CONCLUSION: The maternal TFEB level is determined by early
gestation BMI and later augmented in GDM by a proposed adaptive
placental effort. Future larger studies are required to establish the role of
the TFEB mediated lysosome autophagy in maternal adaptation to normal
and complicated gestation and implication to future therapies.
*Figure(s) will be available online.

S-053
Identification of Independent Metabolic Risk Profiles for 7-Day
Readmission of Late Preterm Infants Using Machine Learning. Scott P
Oltman,2 Ribka Amsalu,2 Elizabeth E Rogers,2 Matthew Pantell,2 Rebecca
J Baer,1 James G Anderson,2 Martina A Steurer,2 J Colin Partridge,2 John
M Dagle,3 Larry Rand,2 Kelli K Ryckman,3 Laura L Jelliffe-Pawlowski*.2
1
University of California San Diego, La Jolla, CA, United States;
2
University of California San Francisco, San Francisco, CA, United
States; 3University of Iowa, Iowa City, IA, United States.
INTRODUCTION: Late-preterm infants are at high risk of readmission
even if they appear healthy at birth. Additionally, the morbidities causing
rehospitalization of these infants are associated with less mature metabolic
systems. We hypothesized that we could identify infants at risk for
readmission using routinely collected newborn metabolic profiles.
METHODS: This retrospective cohort study included all singleton live
births in California between 2005 and 2011 with gestational ages (GA)
from 34 to 36 completed weeks and a discharge within 3 days of birth.
All data included was obtained from linked birth cohort files from the
California Office of Statewide Health Planning and Development and the
California Newborn Screening program. Cases were defined as any infant
with a readmission within 7 days after birth discharge, and the referent
group included all infants discharged with no readmission. Recursive
partitioning was used to develop a conditional inference tree pruned to a
maximum of five splits. A Bonferonni corrected p-value of ≤0.05 generated
hypothesis testing was used as splitting criteria. Variables considered in
the model included infant characteristics and 57 multiple-of-the-median
transformed metabolites. Relative risks (RR) with 95% confidence
intervals (CIs) were calculated for each profile.
RESULTS: Within our sample of 49,866 infants, 5,343 (10.7%) were
readmitted. Recursive partitioning identified 21 independent risk groups.
Rates of readmission within these risk groups ranged from about 1 in 18
to 1 in 4 (table). Individuals at highest risk were those with high levels of
C16:1, a high tyrosine to ornithine ratio, and having an assisted or vaginal
birth (RR 5.3, 95% CI 4.5-6.3; Figure). Other metabolites associated with
higher risk of readmission included high levels of C14:1 and high levels of
C3. Additionally, infants who were delivered via cesarean section tended
to have lower risks of readmission.
CONCLUSION: Risk profiles combining metabolites and infant
characteristics can be used to discriminate between infants at high and low
risk for 7-day readmission. These profiles may contribute to identifying
high risk infants who may benefit from more care prior to discharge.
*Figure(s) will be available online.

S-054
Risk of Hemorrhage in Patients Receiving Intrapartum Magnesium
Sulfate Using Quantitative Blood Loss Estimation. Cara D Dolin†,1
Christianne Persenaire,2 Ashley S Roman*.1 1New York University
Langone Health, New York, NY, United States; 2Northwestern Medicine,
Chicago, IL, United States.
INTRODUCTION: Estimating blood loss at time of delivery has
historically been a challenge. Visual estimates, including use of visual
cues, are inaccurate. Our institution uses quantitative blood loss (QBL)
estimation to allow for accurate, early recognition of postpartum
hemorrhage (PPH). Magnesium sulfate (MgSO4) is frequently used during
delivery in obstetrical patients however, given its properties as a smooth
muscle relaxant, there is some concern that MgSO4 may increase risk
of uterine atony and PPH. Studies using visual estimations of blood loss
have demonstrated that MgSO4 is not associated with an increased risk
of PPH. No studies have been done on this subject using QBL estimation.
Our aim was to use our QBL protocol to determine if MgSO4 increases
the risk of PPH in women requiring MgSO4 at time of delivery.

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