584: Maternal-fetal medicine physician's opinions regarding risk of death and medically indicated termination of pregnancy

Abstract

Obesity in pregnancy bears unique maternal and fetal risks, including an increased risk for gestational diabetes and metabolic perturbations in the offspring. Obesity has also been associated with chronic inflammation, including elevated levels of IL-6 and TNF-alpha. Levels of serum lipopolysaccharides (LPS) rise with increased gut permeability, and have been implicated in driving this inflammation, a phenomenon called metabolic endotoxemia (ME). GLP-2, a proglucagon-derived peptide believed to be integral in maintaining the integrity of the intestine in the face of LPS-mediated endotoxemia. However, variations in these likely molecular mediators in pregnancies among normal, obese, and women with excess weight gain have not yet been explored. We hypothesized that obesity and/or excess weight gain in pregnancy would be associated with an increase in maternal and neonatal markers of ME, as well as GLP-2. STUDY DESIGN: Paired maternal and neonatal (cord blood) serum samples (n¼161) were obtained from our pregnancy biobank repository. Serum levels of LPS, endotoxin core antibody (EndoCAb-IgM), and GLP-2 were measured by ELISA. IL-6 and TNF-alpha were measured using a Milliplex assay. Results were stratified by maternal body mass index (BMI), diabetes, and gestational weight gain (GWG). RESULTS: Maternal IL-6 is significantly decreased in the obese, diabetic cohort compared with the non-obese, non-diabetics (95.28 vs. 99.48 pg/mL, p¼0.047) while GLP-2 is significantly increased (1.92 vs. 2.89 ng/mL, p¼0.026). Neonatal TNF-alpha is significantly decreased in the obese cohort compared to the non-obese (12.43 vs. 13.93 pg/mL, p¼0.044). Maternal GLP-2 is significantly increased in women with excess GWG compared with those with normal GWG (2.27 vs. 1.48 ng/mL, p¼0.014, Figure). We further found that neonatal IL-6 and TNF-alpha are negatively correlated with maternal BMI (-0.186, p¼0.036 and-0.179, p¼0.044 respectively), and that maternal and neonatal IL-6 showed a positive correlation (0.348, p<0.001). CONCLUSION: While we observed altered levels of markers of inflammation (IL-6 and TNF-alpha) with maternal obesity and diabetes, no changes in LPS or endoCAb-IgM were observed. We hypothesize that the increased GLP-2 levels in maternal serum in association with excess GWG may protect against ME in pregnancy.

Society for Maternal-Fetal Medicine Special Statement: Maternal-fetal medicine subspecialist survey on abortion training and service provision

“…This study considered the attitudes of MFM subspecialists about abortion services for high-risk individuals and their competence in abortion provision. Previous surveys aimed at MFM subspecialists have assessed the barriers to provision of D&E, 23 compared their attitudes and practice patterns for second-trimester abortions indicated for abnormal pregnancies with those of trained family planning subspecialists, 16 and assessed the risk for maternal death at which point an abortion would be considered medically indicated or recommended, 24 all of which demonstrated heterogeneity in MFM physicians' attitudes and practice patterns regarding abortion. A strength of this survey includes the breadth and depth of family planning topics assessed, from personal training experience and practice patterns to factors that influence the decisions to provide abortion care.…”