December 2001

A m J Obstet Gynecol

$116 SMFM Abstracts

125

PREGNANCIES AFI'ER ASSISTED REPRODUCTION--HIGHER RISK FOR

ADVERSE O U T C O M E UWE LANG t, J U L I O HERRERO ], A BECK l, T
STALF2, C MEHNERT 2, H GIPS2; lJus tus-Liebig-Univer sitar Giessen, Obstetrics
and Gynecology, Giessen, Hessen; 2Institute of Reproductive Medicine Giessen,
IVF, Giessen, Hessen
OBJECTIVE: Pregnancies after assisted r e p r o d u c t i o n (IVF/ICSI) are
considered to be risk pregnancies. The goal of our study was to assess whether
a n d in which aspects the course of these pregnancies a n d perinatal outcome
after [VF differ from pregnancies not conceived through assisted reproduction.
STUDY DESIGN: 406 pregnancies after IVF between 1994 a n d 1999 were
examined. Data were c o m p a r e d with those of 338,737 patients without any
form of sterility treatment from the statewide perinatal survey of the state of
Hesse/ Germany (HEPE) for the same period. Additionally, within the IYT
group, subgroups for PCO, hyperstimulation a n d other factors were formed
a n d evaluated.
RESULTS: 300 (73.9%) o f the p r e g n a n c i e s after 1VF were singleton
pregnancies, 97 (23.9%) twin p r e g n a n c i e s a n d 9 (2.2%) triplets. After
grouping HEPE data for age a n d parity to match the IVF group, in singleton
pregnancies we f o u n d a high late of early vaginal bleeding (1VF 15.7%; HEPE
2.5%; P < .05), PIH (IVF: 6.3 %; HEPE 2.1%; P < .05), gestational diabetes (IVF:
4.0%; HEPE 0.8%; P < .05), a n d premature labour (IVF: 25.7%; HEPE 7.3%; P
< .05) in the 1VF group. Consequently p r e g n a n c i e s after 1VF h a d a high
prematurity (IVF 20.3%; HEPE 6.7%; P < .05) a n d caesarean section late (IVF
35.7%; HEPE 19.9%; P < .05). Perinatal mortality in the IVF g r o u p was 1.0%
(HEPE 0.6%). Furthermore, 16.8% of the newborns after IVF were growth
restricted (HEPE 8.0%; P < .05); 4.4% were severely growth restricted (<3rd
Percentile). Similar results were observed c o m p a r i n g twin pregnancies.
Subgroups of IVF patients h a d even higher risks for e.g. gestational diabetes,
hypertension a n d prematurity. Interestingly, impaired sperm morphology was
associated with an increased IUGR late.
CONCLUSION: Pregnancies after 1VF therapy are high risk pregnancies
when c o m p a r e d to a s t a n d a r d collective (HEPE) m a t c h e d for n u m b e r of
fetuses, age a n d parity. Subgroups of IVF patients show even higher rates of
specific pregnancy risks, impaired sperm morphology seems to be linked to
IUGR.

126

MATERNAL AGE AND RISK O F FETAL DEATH IN TWIN GESTATIONS IN

T H E UNITED STATES JOSEPH CANTERINO t, CANDE ANANTH 2, J O H N
SMULIAN2, J O H N HARRIGAN 3, ANTHONY VINTZILEOS2; i UMDNJ-Rober t
Wood J o h n s o n Medical School/Saint Peter's University Hospital, Obstetrics,
Gynecology a n d Reproductive Sciences, New Brunswick, NJ; 2UMDNJRobert
Wood J o h n s o n Medical School/Saint Peter's University Hospital, Obstetrics,
Gynecology a n d Reproductive Sciences, New Brunswick, NJ; 3Jersey Shore
Medical Center, Maternal-Fetal Medicine, Neptune, NJ
OBJECTIVE: To evaluate the i n d e p e n d e n t contributions of y o u n g a n d
advanced naaternal age on fetal death in twin gestations a n d compare these
risk profiles with other c o m m o n indications for a n t e p a r t o m testing.
STUDY DESIGN: Retrospective c o h o r t analysis of twin gestataions
between 1995-97 in the United States using linked birth-infant death data was
p e r f o r m e d . Gestational age <20 weeks a n d fetuses with anomalies were
excluded. Fetal death rates with maternal ages 20-34 were c o m p a r e d with
y o u n g (<20 years) a n d advanced age (35-39 years a n d _>40 years). Fetal death
rates for c o m m o n indications for a n t e p a r t u m testing i n c l u d i n g c h r o n i c
h y p e r t e n s i o n (CHTN), p r e g n a n c y - i n d u c e d hypertension (PIH), diabetes
(DM), a n d small for gestational age (SGA) births were evaluated. I n d e p e n d e n t
contributions of young a n d advanced ages, CHTN, PIH, DM a n d SGA births
for the risk of fetal death were d e t e r m i n e d based on multivariable logistic
regression models. Relative risk (RR) a n d 95% confidence intervals (CI) were
derived f r o m these models after adjusting for b i r t h order, gravidity, race,
marital status, prenatal care, education a n d smoking.
RESULTS: A m o n g the 275,901 births, fetal d e a t h o c c u r r e d in 2,097
(0.8%). Fetal death rate a n d RR for maternal age categories, CHTN, PIH, DM
a n d SGA are shown in the Table. W h e n the analysis was restricted to delivery
_>32weeks similiar risk profiles were noted.
CONCLUSION: Young maternal age is independently associated with an
increased risk for fetal death. The magnitude of these risks is similiar to those
of other c o m m o n indications for a n t e p a r t u m testing. Advanced maternal age
appears to reduce the risk of fetal death.
Table
Fetal death rate in twin gestations
GROUP
<20
20-34
35-39
>_40
CHTN
PIH
DM
SGA

TOTAL BIRTHS

D E A T H S (N)

RATE

19,997
207,456
40,743
7,705
2,462
23,234
9,156
25,050

260
1,546
239
52
22
115
57
620

13.0
7.5
5.9
6.7
8.9
4.9
6.2
24.8

R R (95% CI)
1.8
1.0
0.8
0.9
1.2
0.6
0.8
4.3

(1.5-2.0)
(Referent)
(0.7-0.9)
(0.7-1.2)
(0.8-1.8)
(0.5-0.8)
(0.6-1.1)
(3.9-4.7)

127

METOCLOPRAMIDE CONCENTRATION IN BREAST MILK O F WOMEN

DELIVERING BETWEEN 23-34 WEEKS GESTATION WENDY HANSEN I,
STEPHEN H U N T E R 1, STEPHANIE MCANDREW ~, KATHLEEN HARRIS 3,
BRIDGET ZIMMERMAN4; University of Iowa Hospitals a n d Clinics,
Obstetrics a n d Gynecology, Iowa City, IA; 2University of Iowa Hospitals a n d
Clinics, Iowa City, IA; 3University of Wisconsin Medical School, Madison, WI;
4University of Iowa College of Public Health, Biostatistics, Iowa City, IA
OBJECTIVE: Metoclopramide (MC) is generally accepted to be a n
effective lactagogne. We determined the concentration of MC in the breast
milk of women with preterm infants (23-34 weeks gestation).
STUDY DESIGN: Breast milk samples were obtained from 14 mothers
taking MC who delivered p r e t e r m infants. Subjects were chosen r a n d o m l y
from the experimental g r o u p (n = 34) of a larger randomized, double blind,
placebo-controlled study (n = 69). Within 96 hours after birth, women took 10
m g of MC three times a day for 10 days. Breast milk samples were taken on day
10 -+ 2 a n d sent to National Medical Services (Willow Grove, PA) for a highpressure liquid c h r o m a t o g r a p h y assay of the MC levels in the milk. All samples
except one were extracted from a 24-hour collection of expressed breast milk.
Breast milk samples f r o m two m o t h e r s taking placebo were analyzed as
controls.
RESULTS: Breast milk assays of the two women in the placebo g r o u p did
not detect MC. The mean level of MC excreted into the breast milk of the 14
subjects was 44.8 + 20.4 n g / m L . The median (25th-75th percentile) level of
MC in breast milk was 45 (28-56) n g / m L .
CONCLUSION: Mean levels of metocloplamide in preterm breast milk
are similar to levels f o u n d in studies of term subjects. Breast milk levels are
similar to the reported therapeutic range of 40-80 n g / m L in the plasma of
adults taking 10 mg TID. We calculated the m a x i m u m possible exposure to
infants in our study to be 0.011 m g / k g / d a y . This is about 3% of the recomm e n d e d daily dosage (0.5 m g / k g / d a y ) for children. This is similar to findings
on term infants.

128

THIRD-TRIMESTER UNEXPLAINED INTRAUTERINE FETAL DEATH IS

N O T ASSOCIATED WITH THROMBOPI-UI.I& RONIT BECK-FRUCHTER t,
YASSER HUJEIRAT 2, STAVIT SHALEV"2, ZOHAR NAHUM 1, AMIR WEISS 1,
ZEEV WEINER t, ELIEZER SHALEV'3; t H a ' E m e k Medical Center, Obstetrics
a n d Gynecology, Afnla; 2 H a ' E m e k Medical Center, H u m a n Genetic Unit,
Afula; 3Technion-Israel Institute of Technology, R a p p a p o r t Faculty of Medicine, Haifa
OBJECTIVE: To d e t e r m i n e the frequency of i n h e r i t e d a n d a c q u i r e d
thrombophilia a m o n g women with third-trimester unexplained intrauterine
fetal death (IUFD).
STUDY DESIGN: All women with IUFD after 24 weeks gestation in a 3-year
period were initially assessed. Cases with congenital anomalies, intrauterine
infection, feto-maternal bleeding or diabetes mellitus were excluded. The
remaining 53 women were matched for ethnicity with 53 healthy women with a
n o r m a l obstetrical history. All women, in b o t h groups were tested for
mutations of factor V Leiden, p r o t h r o m b i n gene, MTHFR, for the deficiencies
of protein S, protein C, anti t h r o m b i n III a n d for lupus anticoagulant a n d
anticardiolipin antibodies.
RESULTS: The prevalence of any t h r o m b o p h i l i a was 40% in the study
g r o u p c o m p a r e d to 32% in the control g r o u p (P = .54). Inherited thrombophilia was f o u n d in 32% of the study c o m p a r e d to 21% of controls (P= .27).
The late of acquired thrombophilia did not differ between the groups (20% vs.
19%, respectively). The rate of combined thrombophilias was 15% vs. 7.5% (P
= .36).
CONCLUSION: Third-trimester unexplained IUFD is not associated with
thrombophilia.