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Poster Session V Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging www.AJOG.org

779 Elevated second trimester interleukin-6nd increased risk of preeclampsia

Molly Houser1, Methodius Tuuli1, Jeaninearbone1, George Macones1

1Washington University in St. Louis, St. Louis, MOOBJECTIVE: Emerging evidence suggests that inflammatory mediators,uch as cytokine interleukin-6 (IL-6), may play a role in the develop-

ent of preeclampsia. We sought to demonstrate an association be-ween elevated second trimester levels of IL-6 and subsequent devel-pment of preeclampsia.

STUDY DESIGN: We performed a secondary analysis of data from aulticenter, randomized, controlled trial which enrolled patients be-

ween 6 and 20 weeks gestation. Data was collected on maternal de-ographics, local and systemic infections, periodontal disease, and

regnancy outcomes. Of the 1,612 patients tested at 20 weeks, a totalf 105 (6.5%) patients developed preeclampsia. The incidence of pre-clampsia was higher in those with elevated IL-6 (9.8%) compared tohose with normal IL-6 (5.8%, p�0.015). Demographic and medicalharacteristics were similar with the exception of higher rates in thelevated IL-6 group of second trimester urinary tract infectionp�0.042), bacterial vaginosis (p�0.055), and trichomoniasisp�0.055). Higher rates of preeclampsia persisted in the elevated IL-6roup after adjusting for these differences (aOR 1.69, 95% confidencenterval 1.06-2.68, p�0.016).

CONCLUSIONS: Elevated second trimester levels of cervicovaginal IL-6re associated with an increased risk of developing preeclampsia.

780 First trimester dried blood ADAM-12 as a markeror preterm severe pre-eclampsia (PEC) andntrauterine growth restriction (IUGR)

Monica Sood1, Burton Rochelson2, David Krantz3,achel Ravens3, Kuanglin He3, Jon Carmichael3,errence Hallahan3, Hima Tam Tam1

1North Shore University Hospital, Manhasset, NY, 2North Shore Universityospital, New York, NY, 3NTD Labs/PerkinElmer, Melville, NY

OBJECTIVE: To investigate whether first trimester dried blood AD-M-12 can be used as a marker for severe PEC during the first trimes-

er.STUDY DESIGN: This is a retrospective case control study of patients

ho underwent first trimester aneuploidy screening, and later devel-ped PEC and delivered at our institution. ADAM-12 was measured

n dried blood spot using a modified Perkin Elmer AutoDELFIA assay.alues were converted to MoMs and then corrected for maternaleight and race. Data were analyzed using logistic regression and Fis-

her’s exact test.RESULTS: 202 patients were diagnosed with PEC between 1/2007 and

/2010. Of these, 42 patients met ACOG criteria for severe PEC. 18 ofhese patients delivered preterm, and 8 of these had IUGR as well. 24atients had PEC at term, and 6 of these had IUGR as well. A group of234 unaffected patients were identified and used as controls to gen-rate a normal distribution for ADAM-12. There was a statisticallyignificant difference in the percentage of patients with low ADAM-12below the 5th and the 10th percentiles) between the PEC group com-ared to the unaffected group (Fischer’s exact test; p�0.012 and�0.004 for the 5th and the 10th percentile, respectively, see table).ven after excluding the term PEC group, the differences were stilltatistically significant. (p�0.005 and p�0.007, respectively).

CONCLUSIONS: The utility of ADAM-12 in predicting PEC is unclear ashere is conflicting data in the literature. Our data show that AD-M-12 is decreased in patients with severe PEC associated with pre-

erm delivery or IUGR. Additionally, ADAM-12 is a potential markeror use in an early gestational multi-marker screening protocol forrediction of severe PEC.

S306 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

Table 1

% of Patients with ADAM-12 levels

OutcomeMedianMoM

< 5thpercentile

< 10thpercentile

naffected 1.00 4.9 10.1..........................................................................................................................................................................................

Term PEC 0.96 0.0 0.0..........................................................................................................................................................................................

Term IUGR, PEC 0.86 33.3 33.3..........................................................................................................................................................................................

Preterm PEC 0.70 20 30..........................................................................................................................................................................................

Preterm IUGR, PEC 0.84 12.5 37.5..........................................................................................................................................................................................

781 Is smoking protective againstreeclampsia in obese women?

Nicole Marshall1, Camelia Guild2, Yvonne W.heng3, Aaron Caughey1, Donna Halloran2

1Oregon Health & Science University, Portland, OR, 2Saint Louis University,Saint Louis, MO, 3University of California, San Francisco, San Francisco, CAOBJECTIVE: Obesity is a risk factor for preeclampsia. Women whomoke are at decreased risk of preeclampsia, but it is unclear the im-act of smoking on preeclampsia in obese women. Our objective waso determine the impact of smoking status, maternal obesity, and racen the development of preeclampsia.

STUDY DESIGN: This is a retrospective cohort study of birth recordsinked to hospital discharge data for all live born singleton infantsorn to African American or Caucasian Missouri residents from000-2006. We excluded major congenital anomalies and womenith diabetes or chronic hypertension. Obesity was defined as pre-regnancy body mass index � 30 kg/m2. We performed a stratified

multivariable regression model for each race and adjusted for mater-nal age, education, adequate prenatal care, married, nulliparous,Medicaid, male gender, and term.RESULTS: There were 883,414 births meeting study criteria. 27.8%37,113) of African American and 20.2% (151,085) of Caucasianothers were obese. Smoking was more prevalent among Caucasianomen compared to African American women (20.1% vs. 12.7%).frican American women were more likely to develop preeclampsia

han Caucasian women (aOR 1.21, 95% CI 1.18, 1.25). Smoking wasrotective against preeclampsia compared to not smoking (3.86% vs..49%, aOR 0.77, 95% CI 0.75, 0.79). Obesity was associated with anncreased risk of preeclampsia (8.89% vs. 4.18%, aOR 2.37, 95% CI.32, 2.42). Obese smokers were not at increased risk of preeclampsia,egardless of race (table).

CONCLUSIONS: In both African American and Caucasian women,bese smokers are not at increased risk for preeclampsia despite theignificantly increased risk of preeclampsia in obese women. Thisnding may help provide additional insight into the pathogenesis ofreeclampsia.

Table Multivariable Regression Models Assessing risk of Preeclampsiafor African American and Caucasian women

AfricanAmerican Caucasian

%aOR†(95% CI) p-value %

aOR†(95% CI) p-value

Smoker 10.22 0.94(0.86, 0.98)

0.0131 15.01 0.75(0.73, 0.77)

�.0001

..........................................................................................................................................................................................

Obese 38.55 1.84(1.75, 1.93)

�.0001 36.14 2.51(2.45, 2.57)

�.0001

..........................................................................................................................................................................................

Obesesmokers

3.8 0.91(0.78, 1.06)

0.2353 5.3 0.96(0.90, 1.02)

0.1542

..........................................................................................................................................................................................

Non-obesenon-smokers

55.0 referent 54.2 referent

..........................................................................................................................................................................................

†adj. for Medicaid, age (18-34), education, adequate prenatal care, married, nulliparous,previous C/S, primary elective C/S, male gender, and term.

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