SRI Supplement to Reproductive Sciences - Volume 25 Number 1 - March 2018 - 241A

Scientific Abstracts

F-180
Does BMI Affect Outcomes in Patients That Have Preeclampsia
with Severe Features? Dyese Taylor†, Reena Parikh†, Natalie Porat†,
Melissa ChuLam†, Dawnette Lewis*, Barak Rosenn*. Mount Sinai West,
NY, NY, United States.
INTRODUCTION: The objective of this study was to test the hypothesis
that in patients that have preeclampsia with severe features (PSF), the
clinical presentation and pregnancy outcomes are worse in lean patients
compared to overweight/obese patients.
METHODS: This was a retrospective study of patients diagnosed with
preeclampsia with severe features after 24 weeks, from October 2013-June
2017, in an inner city hospital. The lean patient group (LG) was defined
as those having a pre-gravid BMI <25 while the obese/overweight patient
group (OG) was defined as those with a BMI ≥25. The 2 groups were
compared with respect to clinical characteristics (presenting symptoms,
time from admission to delivery, number of doses of IV antihypertensive
medication and lab abnormalities). The primary outcome of the study was
delivery <34 weeks. Secondary outcomes included delivery <28 weeks,
a composite maternal outcome (ICU admission, placental abruption,
need for blood transfusion, or the presence of HELLP syndrome) and a
composite neonatal outcome (NICU admission or birth weight ≤ 3rd %).
In addition, we examined the association of these outcomes with BMI
as a continuous variable.
RESULTS: 321 patients with severe preeclampsia were studied: 174 in
the LG and 147 in the OG. Race distribution of the groups was statistically
different; otherwise, demographics and clinical characteristics were
similar (Figure 1). The LG required more IV anti hypertensive treatment,
had higher rates of vaginal delivery and higher gestational age at delivery
than the OG (Figure 2). Otherwise, there were no differences with respect
to preterm delivery and composite neonatal or maternal outcomes.
Similarly, when analyzed as a continuous variable, BMI demonstrated
poor correlation with all outcomes.
CONCLUSION: Maternal BMI does not have a significant effect on
maternal or neonatal outcomes in patients who have preeclampsia with
severe features.
*Figure(s) will be available online.

241A

F-181
Menadione Increases Endogenous Carbon Monoxide Production in
Pregnant Mice. Chioma U Odozor†, Nichole Peterson, Jessica Pudwell,
Graeme N Smith*. Queen's University, Kingston, ON, Canada.
INTRODUCTION: Pre-eclampsia (PE) is a multifactorial disease
affecting 5-8% of pregnancies worldwide. Women who smoke have
a significantly decreased risk of PE, which has been attributed to an
increase in carbon monoxide (CO) concentration in the body up to
14% carboxyhemoglobin (%COHb), compared to a baseline level of
approximately 1.5%. Despite its vasodilatory and anti-inflammatory
properties, therapeutic CO administration is not widely accepted.
Menadione (MD), a synthetic form of vitamin K, increases endogenous
CO production in perfused human term placental tissue. Thus, the use of
menadione to increase CO production in female mice was investigated.
Objective: To quantify CO production in pregnant mice treated with MD,
and elucidate its effects on maternal-fetal health.
METHODS: A preliminary dose-response using 0 - 6.5 g/L menadione
sodium bisulfite (Sigma-Aldrich) in drinking water for seven days was
conducted in female nonpregnant CD-1 mice (Charles River, USA).
From this, 6.5 g/L MD was selected for administration in pregnant mice
from GD10.5 to GD17.5. Water was provided ad libitum to all mice and
measured as average daily water intake per gram of body weight (mL/24
hr:g). Baseline water intake was measured for four days prior to MD
treatment to monitor for signs of taste aversion to the drug. Maternal and
fetal %COHb levels for the treated and control groups were compared
and calculated from CO peak area values using gas chromatography
(GC). 20% w/w sonicates of perfused maternal hepatic, renal, splenic
and placental tissue were also analyzed using GC to quantify tissue CO
levels in the control and treatment groups.
RESULTS: The daily administration of MD to pregnant mice resulted in
a positive trend of CO production in all sampled maternal tissue, with a
significantly higher tissue CO level in the spleen (p<0.0001) compared to
the control. %COHb did not increase above 1% in treated dams. Placental
efficiency and maternal weight gain during the gestational period were
significantly lower in the treatment group (p<0.05).
CONCLUSION: MD is an alternative method of increasing CO
production in a healthy murine pregnancy model. Further investigation in
a mouse model of PE is necessary to support the possibility of therapeutic
benefit for this disease. Support: Canadian Institutes of Health Research

F-182
Trends in Cesarean Delivery Rate Following the Implementation
of New Induction Recommendations by ACOG in Patients with
Gestational Hypertension. Katherine McCormick†,1 Kavita Narang†,1
Christine Nkemeh†,1 Stephanie Flermoen†,1 David Colombo*,2 Vivian
Romero Romero*.2 1Michigan State University, Grand Rapids, MI, United
States; 2Spectrum Health, Grand Rapids, MI, United States.
INTRODUCTION: To determine if the rate of cesarean delivery (CD)
in patients induced due to gestational hypertension had changed after
the implementation of new recommendation on timing of delivery by
ACOG in 2013.
METHODS: This is a retrospective cohort study of gestational
hypertensive patients induced before and after the implementation of
new guidelines for induction of labor by ACOG at Spectrum Health
Butterworth Hospital between 2010 and 2015. Patient's data was
collected before (01/2010- 03/2013) and after (05/2013- 12/2015) the
new recommendation was implemented. Our primary outcome was to
determine if there was a significant change in the cesarean delivery rate
following the new recommendation. Chi- square and Fischer's exact test
were used to analyze data and regression analysis was used to adjust for
confounders.
RESULTS: A total of 332 women met inclusion criteria. There was a
significant difference in gestational age at induction between both groups(
39/1 before vs 38/4 after 2013)(p<0.001); There were more multiparas
in the group after(p=0.025). No significant differences were identified
in the remaining baseline characteristics. A statistically significant
difference was initially found in the cesarean delivery rates between
both groups (before 46 of 161(28.6%) and after the recommendation

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complicated by PE have decreased mitochondrial integrity as manifested
by increased mitochondrial DNA (mtDNA) damage, and increased fission
which eventually results in decreased ATP production.
METHODS: Placental tissues from singleton pregnancies were obtained
from the MCW maternal research placenta & cord blood bank. Samples
were separated by maternal and fetal sides of the placenta and into PE
and control groups.
Quantitative PCR assessed the integrity of the mitochondrial genome.
Placental proteins were extracted and immune assays were conducted to
detect relative expression of mitofusin (MFN) and dynamin related protein
1 (DRP-1), indicators of mitochondrial fusion and fission respectively.
RESULTS: PCR analysis found an average of 0.032 lesions per 10Kb
out of 3 placenta samples in the control group. By contrast, the amount
of mtDNA damage in the 3 PE samples averaged 0.24 lesions/10Kb (~7fold increase) (PE 0.24±0.11* vs. control 0.032±0.085, N=3, *p=0.011).
*Figure(s) will be available online.
Similarly, expression of active DRP-1 displayed a trend towards increased
levels in PE samples compared to placental samples (PE 13.87±7.67*
N=3 vs. control 1.00±0.26 N=7, *p=0.03). MFN1, by contrast, trended
towards decreased expression in PE samples compared to healthy controls
(PE 0.10±0.04 N=3 vs. control 1.00±0.30 N=7, p=0.14).
*Figure(s) will be available online.
CONCLUSION: In preeclamptic placentas there are greater levels
of mitochondrial DNA damage and a trend towards increased rates of
baseline mitochondrial fission-an indicator of mitochondrial stress
and dysfunction. Mitochondrial dysfunction may play a key role in the
pathogenesis of PE and may serve as a novel target for the treatment of
the disease.

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