Oral Concurrent Session 1 - Prematurity
Oral Concurrent Sessions
Bob M. Silver, MD
Chair OB/GYN
University of Utah, School of Medicine
Salt Lake City, Utah, United States
George R. Saade, MD (he/him/his)
Professor & Chair of Ob-Gyn
Eastern Virginia Medical School
Norfolk, VA, United States
Matthew Hoffman, MD, MPH
Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology at Christiana Care
Christiana Care Health Systems
Newark, DE, United States
Lynn M. Yee, MD, MPH (she/her/hers)
Associate Professor
Northwestern University
Chicago, IL, United States
.jpg "Lisa D. Levine, MD, MSCE (she/her/hers) photo")
Lisa D. Levine, MD, MSCE (she/her/hers)
Associate Professor
University of Pennsylvania
Philadelphia, PA, United States
Disclosure(s): I have no relevant financial relationships to report.
Brian M. Mercer, MD
Department Chair of Obstetrics & Gynecology
MetroHealth Medical Center
Cleveland, OH, United States
Judith H. Chung, PhD,MD,PhD
Professor of Clinical Obstetrics and Gynecology
UC Irvine Health
Orange, CA, United States
Uma M. Reddy, MD, MPH
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
Nulliparas are at increased risk of adverse pregnancy outcomes [APOs]; once an individual has an APO, they are at risk of recurrence. Little is known about markers, independent of prior APO, that are associated with recurrent APO. This analysis proposed to ascertain factors identified early in a first pregnancy that are associated with an APO in a second pregnancy.
Study Design:
The nuMoM2b Heart Health Study is a cohort of nulliparas followed from the first trimester through delivery who attended an in-person visit 2-7 years after their pregnancy. This analysis is restricted to those who had two pregnancies that extended to at least 20 weeks’ gestation. Demographics, clinical measures, and laboratory values from the first trimester of the first pregnancy were considered as potential risk markers. Race and ethnicity, as social constructs, were evaluated given known disparities in APO. An APO was defined as any of the following: hypertensive disorders of pregnancy, preterm birth < 37 weeks’, small-for-gestational-age birth (< 5th%ile), fetal demise, or gestational diabetes. Logistic regression estimated the association between risk markers and APO in a second pregnancy, controlling for a first pregnancy APO, in order to identify risk markers independent of prior APO.
Results:
Of 4484 participants, the 2830 who met inclusion criteria and comprised the analytic population had a mean (SD) time between pregnancies of 2.9 (1.3) years. Of the 32% with an APO in the first pregnancy, 40% had an APO in the second pregnancy. Of those without an APO in the first pregnancy, 15% developed an APO in a second pregnancy. Multiple markers from the first trimester of the first pregnancy (BMI, race/ethnicity, blood pressure, and cardiometabolic serum analytes) were associated with an APO in the second pregnancy. The magnitude of APO recurrence risk associated with having had an APO in the first pregnancy varied by race/ethnicity (TABLE).
Conclusion:
Multiple markers in a first pregnancy, including some that are modifiable, are associated with an APO in a second pregnancy, suggesting potential targets for intervention.