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We evaluated pregnancy outcomes in obese women with excessive weight gain during pregnancy. A retrospective study was performed on all obese women. Outcomes included rates of preeclampsia (PEC), gestational diabetes, cesarean delivery (CD), preterm delivery, low birth weight, very low birth weight, macrosomia, 5-minute Apgar score of7, and neonatal intensive care unit (NICU) admission and were stratified by body mass index (BMI) groups class I (BMI 30 to 35.9 kg/m(2)), class II (36 to 39.9 kg/m(2)), and class III (or=40 kg/m(2)). Gestational weight change was abstracted from the mother's medical chart and was divided into four categories: weight loss, weight gain of up to 14.9 pounds, weight gain of 15 to 24.9 pounds, and weight gain of more than 25 pounds. A total 20,823 obese women were eligible for the study. Univariate analysis revealed higher rates of preeclampsia, gestational diabetes, Cesarean deliveries, preterm deliveries, low birth weight, macrosomia, and NICU admission in class II and class III obese women when compared with class I women. When different patterns of weight gain were used as in the logistic regression model, rates of PEC and CD were increased. Excessive weight gain among obese women is associated with adverse outcomes with a higher risk as BMI increases.

We examined pregnancy outcomes in women receiving nifedipine tocolysis having recurrent preterm labor (RPTL). Singleton gestations enrolled for outpatient nursing surveillance and prescribed nifedipine tocolysis were identified ( N = 4748). Women hospitalized for RPTL at

To identify characteristics indicative of subsequent requirement of insulin in patients with gestational diabetes (GDM).Identified from a database were patients with GDM not receiving insulin or oral hypoglycemic agents at enrollment for outpatient education and surveillance. Maternal characteristics were compared between patients achieving glycemic control with diet and those requiring insulin. Cox proportional hazards regression was used to assess multiple effects of significant univariate factors.Data from 2365 patients were analyzed. Patients requiring insulin were more likely to be multiparous, obese, have a history of GDM, be diagnosed at28 weeks of gestation, and have a fasting blood glucose of95 mg/dL, a glucose tolerance test 3-hour blood glucose of140 mg/dL, and a glycosylated hemoglobin (A1c) ofor=6% at diagnosis of GDM.Laboratory values at diagnosis of GDM were the strongest indicators of subsequent need for insulin treatment. Patients with fasting blood glucose of95 mg/dL and A1c valuesor=6% at diagnosis of GDM should receive close surveillance of daily blood glucose.

We evaluated the impact of adherence to the new Institute of Medicine weight gain guidelines within each prepregnancy body mass index (PPBMI) category on the development of pregnancy-related hypertension (PRH). Patients with singleton term deliveries (≥37 weeks) with documented PPBMI and pregnancy weight gain information were identified from a database of women enrolled for outpatient nursing services. Included were women without history of cardiovascular disease, PRH, or diabetes at initiation of services (N = 7676). Data were stratified by PPBMI (underweight = < 18.5 kg/m(2); normal weight = 18.5 to 24.9 kg/m(2); overweight = 25.0 to 29.9 kg/m(2); obese = ≥ 30.0 kg/m(2)). PRH rates were compared overall and within each PPBMI group for those women gaining less than recommendations, within recommendations, and above recommendations using Pearson's chi-square and Kruskal-Wallis H test statistics. Overall, PRH rates were 5.0%, 5.4%, and 10.8% for less than, within, and above recommendation groups, respectively (P < 0.001). Above recommendation weight gain resulted in higher PRH incidence in each PPBMI category (underweight 7.6%, normal weight 6.2%, overweight 12.4%, and obese 17.0%), reaching statistical significance in all but the underweight PPBMI group. Excessive weight gain above established guidelines was associated with increased rates of PRH. Regardless of PPBMI, women should be counseled to avoid excessive weight gain during pregnancy.

The purpose of this study was to identify differences in antepartum uterine contraction frequency (UCF) in twin pregnancies with and without preterm labor (PTL).Twin gestations enrolled for outpatient surveillance with twice daily electronic uterine activity monitoring and telephonic nursing assessment, without interventional delivery were identified. Mean UCF for each gestational week was compared between women without PTL or preterm delivery (PTD)36 weeks (controls) and those with a PTL diagnosis delivering at36 weeks (PTL/PTD group), and those with PTL with deliveryor = 36 weeks (PTL/GADor = 36 group).Data from 7891 patients with 267,840 monitored hours were analyzed. UCF at each gestational week was significantly higher for patients experiencing PTL with or without PTD compared to control. UCF was similar for patients with PTL with or without PTD36.Twin pregnancies complicated with PTL have a higher UCF than those that do not experience PTL. Outpatient surveillance may be beneficial in this population.

173 A comparison of cervical cerclage and vaginal pessaries in the prevention of spontaneous preterm birth in women with a short cervix Katherine Scolari Childress, Amy Flick, Erin Dickert, Jeffrey Gavard, Ricardo Bolanos, Gilad Gross St. Louis University, Maternal Fetal Medicine, St. Louis, MO, Saint Louis University, Obstetrics, Gynecology, & Women’s Health, St. Louis, MO, Bon Secours St. Francis Health System, Maternal Fetal Medicine, Greenville, SC OBJECTIVE: Cervical cerclage and vaginal pessaries are both used as treatment strategies for the prevention of spontaneous preterm birth. Our objective was to compare pregnancy and neonatal outcomes in women who had either an ultrasound or exam-indicated cervical cerclage or a vaginal pessary placed for the treatment of a short cervix (