Patrice Wendling

Major Finding: Overall, 75% of patients randomized to Lactobacillus GG returned to normal stool, vs. 70% of those receiving placebo.

Data Source: Double-blind randomized trial of Lactobacillus GG in 129 children with acute infectious diarrhea.

Disclosures: Amerifit Brands Inc. provided the study product and placebo, and a small patient incentive. Dr. Nixon disclosed no conflicts of interest.

VANCOUVER — Contrary to prior studies, Lactobacillus GG did not significantly affect the overall duration or severity of acute infectious diarrhea in a double-blind, randomized trial of 129 children presenting in the pediatric emergency department.

Children with longer diarrheal illness however, appeared to respond better to outpatient use of Lactobacillus GG (LGG), said Dr. Abigail Nixon, a pediatric fellow in training at the Jacobi Medical Center, Bronx, N.Y., at the annual meeting of the Pediatric Academic Societies.

Probiotics have been shown to decrease the duration of infectious diarrhea, although there are no U.S. studies of the use of probiotics to treat infectious diarrhea in the outpatient setting.

The study involved 129 children, aged 6 months to 6 years (mean 25.5 months), presenting to the emergency department (ED) with acute diarrhea, defined as more than two loose stools in the preceding 24 hours (mean 5.3 episodes). Patients were randomized to 10 capsules of dissolvable powder containing LGG or placebo containing inulin, a polysaccharide.

Parents administered the powder twice daily for 5 days and recorded in a home diary the number of stools. A blinded researcher called the caregiver daily for 5 days, and recorded the number of stools and the date and time of the first normal stool.

The percentage of children returning to normal stool during the study period was similar among patients randomized to LGG and those receiving placebo, at 75% and 70%, respectively, Dr. Nixon said.

There also was no significant difference in the median time to normal stool—60 hours with LGG vs. 74 hours with placebo—or in the number of diarrheal stools during the study—5.0 with LGG vs. 6.5 with placebo.

The lack of a significant benefit from LGG may be caused by the fact that children treated and discharged from the ED are in general not as ill as those who are admitted, Dr. Nixon explained, and therefore it's more difficult to document an effect of the probiotic.

“I think there's a population of children who probably have very mild disease who don't benefit from probiotics because they don't need it; they would have gotten better on their own,” she said in an interview. “I think that's why as a group as a whole, we didn't see a meaningful difference.”

Still, the results support a trend for a benefit of probiotics, she added.

Among patients presenting with more than 2 days of diarrhea, a post hoc subgroup analysis revealed that a significantly higher percentage of the LGG patients returned to normal stool than did placebo-treated patients, 79% vs. 58%, respectively.

In addition, LGG patients returned to normal stool almost 24 hours earlier than did their counterparts treated with placebo (51 hours vs. 74 hours), and had half the number of diarrheal stools (3.5 vs. 7). Both differences were statistically significant.

After the researchers adjusted for age, children with more than 2 days of diarrhea treated with LGG were twice as likely to return to normal stool as were children in the placebo group.

“LGG may have a restorative effect on the intestinal flora and therefore would preferentially benefit patients presenting with prolonged diarrhea,” said Dr. Nixon, who recommends probiotics, either as tablets or fortified yogurt, to her patients in the ED.

She noted that a reduction in the time to resolution of diarrhea might have important public health implications in terms of missed work, lost revenue, and school absenteeism.

Diarrhea accounts for about 1.5 million pediatric outpatient visits and more than 200,000 hospitalizations annually in the United States, Dr. Nixon said at the meeting.

An analysis of the study's secondary outcomes among the entire cohort found no difference between groups in the time for patient or parents to return to normal activity or in the need to return for medical care or hospitalization.

Session moderator Dr. Benard P. Dreyer, professor of pediatrics at New York University, wondered whether LGG might have been less effective because of the increasing rate of rotavirus vaccination in children. Dr. Nixon said the impact of rotavirus is unclear, as viral cultures were not conducted.

The population that has very mild disease doesn't benefit from probiotics because they don't need it.

Source DR. NIXON

Major Finding: Overall, 75% of patients randomized to Lactobacillus GG returned to normal stool, vs. 70% of those receiving placebo.

Data Source: Double-blind randomized trial of Lactobacillus GG in 129 children with acute infectious diarrhea.

Disclosures: Amerifit Brands Inc. provided the study product and placebo, and a small patient incentive. Dr. Nixon disclosed no conflicts of interest.

VANCOUVER — Contrary to prior studies, Lactobacillus GG did not significantly affect the overall duration or severity of acute infectious diarrhea in a double-blind, randomized trial of 129 children presenting in the pediatric emergency department.

Children with longer diarrheal illness however, appeared to respond better to outpatient use of Lactobacillus GG (LGG), said Dr. Abigail Nixon, a pediatric fellow in training at the Jacobi Medical Center, Bronx, N.Y., at the annual meeting of the Pediatric Academic Societies.

Probiotics have been shown to decrease the duration of infectious diarrhea, although there are no U.S. studies of the use of probiotics to treat infectious diarrhea in the outpatient setting.

The study involved 129 children, aged 6 months to 6 years (mean 25.5 months), presenting to the emergency department (ED) with acute diarrhea, defined as more than two loose stools in the preceding 24 hours (mean 5.3 episodes). Patients were randomized to 10 capsules of dissolvable powder containing LGG or placebo containing inulin, a polysaccharide.

Parents administered the powder twice daily for 5 days and recorded in a home diary the number of stools. A blinded researcher called the caregiver daily for 5 days, and recorded the number of stools and the date and time of the first normal stool.

The percentage of children returning to normal stool during the study period was similar among patients randomized to LGG and those receiving placebo, at 75% and 70%, respectively, Dr. Nixon said.

There also was no significant difference in the median time to normal stool—60 hours with LGG vs. 74 hours with placebo—or in the number of diarrheal stools during the study—5.0 with LGG vs. 6.5 with placebo.

The lack of a significant benefit from LGG may be caused by the fact that children treated and discharged from the ED are in general not as ill as those who are admitted, Dr. Nixon explained, and therefore it's more difficult to document an effect of the probiotic.

“I think there's a population of children who probably have very mild disease who don't benefit from probiotics because they don't need it; they would have gotten better on their own,” she said in an interview. “I think that's why as a group as a whole, we didn't see a meaningful difference.”

Still, the results support a trend for a benefit of probiotics, she added.

Among patients presenting with more than 2 days of diarrhea, a post hoc subgroup analysis revealed that a significantly higher percentage of the LGG patients returned to normal stool than did placebo-treated patients, 79% vs. 58%, respectively.

In addition, LGG patients returned to normal stool almost 24 hours earlier than did their counterparts treated with placebo (51 hours vs. 74 hours), and had half the number of diarrheal stools (3.5 vs. 7). Both differences were statistically significant.

After the researchers adjusted for age, children with more than 2 days of diarrhea treated with LGG were twice as likely to return to normal stool as were children in the placebo group.

“LGG may have a restorative effect on the intestinal flora and therefore would preferentially benefit patients presenting with prolonged diarrhea,” said Dr. Nixon, who recommends probiotics, either as tablets or fortified yogurt, to her patients in the ED.

She noted that a reduction in the time to resolution of diarrhea might have important public health implications in terms of missed work, lost revenue, and school absenteeism.

Diarrhea accounts for about 1.5 million pediatric outpatient visits and more than 200,000 hospitalizations annually in the United States, Dr. Nixon said at the meeting.

An analysis of the study's secondary outcomes among the entire cohort found no difference between groups in the time for patient or parents to return to normal activity or in the need to return for medical care or hospitalization.

Session moderator Dr. Benard P. Dreyer, professor of pediatrics at New York University, wondered whether LGG might have been less effective because of the increasing rate of rotavirus vaccination in children. Dr. Nixon said the impact of rotavirus is unclear, as viral cultures were not conducted.

The population that has very mild disease doesn't benefit from probiotics because they don't need it.

Source DR. NIXON

Major Finding: Overall, 75% of patients randomized to Lactobacillus GG returned to normal stool, vs. 70% of those receiving placebo.

Data Source: Double-blind randomized trial of Lactobacillus GG in 129 children with acute infectious diarrhea.

Disclosures: Amerifit Brands Inc. provided the study product and placebo, and a small patient incentive. Dr. Nixon disclosed no conflicts of interest.

VANCOUVER — Contrary to prior studies, Lactobacillus GG did not significantly affect the overall duration or severity of acute infectious diarrhea in a double-blind, randomized trial of 129 children presenting in the pediatric emergency department.

Children with longer diarrheal illness however, appeared to respond better to outpatient use of Lactobacillus GG (LGG), said Dr. Abigail Nixon, a pediatric fellow in training at the Jacobi Medical Center, Bronx, N.Y., at the annual meeting of the Pediatric Academic Societies.

Probiotics have been shown to decrease the duration of infectious diarrhea, although there are no U.S. studies of the use of probiotics to treat infectious diarrhea in the outpatient setting.

The study involved 129 children, aged 6 months to 6 years (mean 25.5 months), presenting to the emergency department (ED) with acute diarrhea, defined as more than two loose stools in the preceding 24 hours (mean 5.3 episodes). Patients were randomized to 10 capsules of dissolvable powder containing LGG or placebo containing inulin, a polysaccharide.

Parents administered the powder twice daily for 5 days and recorded in a home diary the number of stools. A blinded researcher called the caregiver daily for 5 days, and recorded the number of stools and the date and time of the first normal stool.

The percentage of children returning to normal stool during the study period was similar among patients randomized to LGG and those receiving placebo, at 75% and 70%, respectively, Dr. Nixon said.

There also was no significant difference in the median time to normal stool—60 hours with LGG vs. 74 hours with placebo—or in the number of diarrheal stools during the study—5.0 with LGG vs. 6.5 with placebo.

The lack of a significant benefit from LGG may be caused by the fact that children treated and discharged from the ED are in general not as ill as those who are admitted, Dr. Nixon explained, and therefore it's more difficult to document an effect of the probiotic.

“I think there's a population of children who probably have very mild disease who don't benefit from probiotics because they don't need it; they would have gotten better on their own,” she said in an interview. “I think that's why as a group as a whole, we didn't see a meaningful difference.”

Still, the results support a trend for a benefit of probiotics, she added.

Among patients presenting with more than 2 days of diarrhea, a post hoc subgroup analysis revealed that a significantly higher percentage of the LGG patients returned to normal stool than did placebo-treated patients, 79% vs. 58%, respectively.

In addition, LGG patients returned to normal stool almost 24 hours earlier than did their counterparts treated with placebo (51 hours vs. 74 hours), and had half the number of diarrheal stools (3.5 vs. 7). Both differences were statistically significant.

After the researchers adjusted for age, children with more than 2 days of diarrhea treated with LGG were twice as likely to return to normal stool as were children in the placebo group.

“LGG may have a restorative effect on the intestinal flora and therefore would preferentially benefit patients presenting with prolonged diarrhea,” said Dr. Nixon, who recommends probiotics, either as tablets or fortified yogurt, to her patients in the ED.

She noted that a reduction in the time to resolution of diarrhea might have important public health implications in terms of missed work, lost revenue, and school absenteeism.

Diarrhea accounts for about 1.5 million pediatric outpatient visits and more than 200,000 hospitalizations annually in the United States, Dr. Nixon said at the meeting.

An analysis of the study's secondary outcomes among the entire cohort found no difference between groups in the time for patient or parents to return to normal activity or in the need to return for medical care or hospitalization.

Session moderator Dr. Benard P. Dreyer, professor of pediatrics at New York University, wondered whether LGG might have been less effective because of the increasing rate of rotavirus vaccination in children. Dr. Nixon said the impact of rotavirus is unclear, as viral cultures were not conducted.

The population that has very mild disease doesn't benefit from probiotics because they don't need it.

Source DR. NIXON

CHICAGO — Researchers have developed a simple scoring system that detects large abdominal aortic aneurysms in a broader at-risk population—including women and those younger than 65 years—than do current screening criteria.

Based on an analysis of 3.1 million patients, the new scoring system estimated the prevalence of 5-cm or greater abdominal aortic aneurysms (AAA) in the United States to be 0.14%, or equivalent to 120,810 aneurysms. The current U.S. Preventive Services Task Force (USPSTF) guidelines would capture just one-third of these large aneurysms, whereas two-thirds would be identified with the new system, principal investigator Giampaolo Greco, Ph.D., said at the annual meeting of the American Surgical Association.

“The score needs to be validated in another cohort, but if validated, we believe these results argue for fundamentally changing current screening policy,” he said.

Dr. Gregorio Sicard called the findings a “landmark in the area of screening for vascular disease.” Dr. Sicard, an invited discussant who is head of vascular surgery at Washington University in St. Louis, said that the current USPSTF guidelines have not been universally encouraged or adopted by vascular surgeons, and that utilization of Medicare's one-time ultrasound screening for AAA has been unsuccessful.

“Use of a strategy with this statistical model will significantly increase and clarify this controversy in which patients are best screened,” he said.

The current USPSTF guidelines, which are designed to identify aneurysms greater than 3 cm in males aged 65–75 years who have ever smoked, are both too narrow and too broad, explained Dr. Greco of the department of health evidence and policy at Mount Sinai School of Medicine, New York. They exclude women, who account for 33% of the 20,000 deaths each year from ruptured AAA, and those younger than 65 years, who account for 10% of AAA deaths. They also identify smaller AAAs that are at a lower risk of rupture, thereby resulting in unnecessary anxiety in low-risk individuals.

Dr. Greco and his associates used multivariate logistic regression analysis to identify risk factors for AAAs in 3.1 million patients undergoing ultrasound screening for AAA by Life Line Screening from 2003 to 2008. Not surprisingly, smoking was found to have a profound influence on the risk for a 5-cm or larger AAA; the risk increased with quantity and duration of smoking and decreased following smoking cessation. Odds ratios ranged from 2.6 for smoking a half-pack or less per day for less than 10 years to 14.5 for smoking more than a half-pack per day for 35 years. The risk of AAA fell dramatically for those who quit smoking for 5–10 years (OR 0.8) and for more than 10 years (OR 0.5), reported Dr. Greco and senior author Dr. K. Craig Kent, chair of the surgery department at the University of Wisconsin in Madison.

Others at elevated risk included males (OR 7.7), those with a family history of AAA (OR 3.2), and those aged 85 years or older (OR 53.1).

Novel findings included a protective effect of exercising at least once per week (OR 0.8), consuming nuts at least four times per week (OR 0.9), and being of black (OR 0.7) or Hispanic (OR 0.7) ethnicity, Dr. Greco said.

Using these and other factors, the researchers developed a scoring system with a good predictive accuracy, as noted by a C statistic equal to 0.81. If AAA screening were performed on the 6.8 million at-risk individuals identified by current screening criteria, 33.7% of the large AAAs would be captured, he said. Based on a score of 36 on the new model, the number of individuals who would need to be screened would be reduced to 6.3 million and nearly 59.3% of AAAs would be identified. “It would take 156 screenings with the current guidelines to get a single AAA, whereas it would take 85 screenings with our scoring system to find one person with AAA,” Dr. Greco said.

Alternatively, if the threshold were lowered to a score of 30, the same level of screening would bring the yield of detected AAAs to 84%, he added.

During a discussion of the findings, Dr. Sicard asked whether a separate scoring system should be developed for women, observing that the analysis contained very few women with large AAAs who were younger than 75 years. One attendee asked whether intervention should begin at a smaller aneurysm size in women, who present with rupture more often than do males and have greater in-hospital mortality. Dr. Greco said that a separate system for women would not be necessary, as they are included in the new model and the stringency of the test on smaller aneurysms is affected by lowering the score threshold. Ultimately, society would need to decide whether additional funds should be allocated to expand screening. A cost analysis is planned, Dr. Greco said in an interview.

Disclosures: Dr. Greco and Dr. Sicard disclosed no conflicts of interest. Dr. Kent has been an investigator on various industry-sponsored trials. A study coauthor disclosed employment with Life Line Screening of America.

It would take 156 screenings with the current guidelines to get a single AAA vs. 85 screenings with this system.

Source DR. GRECO

The risk of AAA fell dramatically for those who quit smoking.

Source DR. KENT

CHICAGO — Researchers have developed a simple scoring system that detects large abdominal aortic aneurysms in a broader at-risk population—including women and those younger than 65 years—than do current screening criteria.

Based on an analysis of 3.1 million patients, the new scoring system estimated the prevalence of 5-cm or greater abdominal aortic aneurysms (AAA) in the United States to be 0.14%, or equivalent to 120,810 aneurysms. The current U.S. Preventive Services Task Force (USPSTF) guidelines would capture just one-third of these large aneurysms, whereas two-thirds would be identified with the new system, principal investigator Giampaolo Greco, Ph.D., said at the annual meeting of the American Surgical Association.

“The score needs to be validated in another cohort, but if validated, we believe these results argue for fundamentally changing current screening policy,” he said.

Dr. Gregorio Sicard called the findings a “landmark in the area of screening for vascular disease.” Dr. Sicard, an invited discussant who is head of vascular surgery at Washington University in St. Louis, said that the current USPSTF guidelines have not been universally encouraged or adopted by vascular surgeons, and that utilization of Medicare's one-time ultrasound screening for AAA has been unsuccessful.

“Use of a strategy with this statistical model will significantly increase and clarify this controversy in which patients are best screened,” he said.

The current USPSTF guidelines, which are designed to identify aneurysms greater than 3 cm in males aged 65–75 years who have ever smoked, are both too narrow and too broad, explained Dr. Greco of the department of health evidence and policy at Mount Sinai School of Medicine, New York. They exclude women, who account for 33% of the 20,000 deaths each year from ruptured AAA, and those younger than 65 years, who account for 10% of AAA deaths. They also identify smaller AAAs that are at a lower risk of rupture, thereby resulting in unnecessary anxiety in low-risk individuals.

Dr. Greco and his associates used multivariate logistic regression analysis to identify risk factors for AAAs in 3.1 million patients undergoing ultrasound screening for AAA by Life Line Screening from 2003 to 2008. Not surprisingly, smoking was found to have a profound influence on the risk for a 5-cm or larger AAA; the risk increased with quantity and duration of smoking and decreased following smoking cessation. Odds ratios ranged from 2.6 for smoking a half-pack or less per day for less than 10 years to 14.5 for smoking more than a half-pack per day for 35 years. The risk of AAA fell dramatically for those who quit smoking for 5–10 years (OR 0.8) and for more than 10 years (OR 0.5), reported Dr. Greco and senior author Dr. K. Craig Kent, chair of the surgery department at the University of Wisconsin in Madison.

Others at elevated risk included males (OR 7.7), those with a family history of AAA (OR 3.2), and those aged 85 years or older (OR 53.1).

Novel findings included a protective effect of exercising at least once per week (OR 0.8), consuming nuts at least four times per week (OR 0.9), and being of black (OR 0.7) or Hispanic (OR 0.7) ethnicity, Dr. Greco said.

Using these and other factors, the researchers developed a scoring system with a good predictive accuracy, as noted by a C statistic equal to 0.81. If AAA screening were performed on the 6.8 million at-risk individuals identified by current screening criteria, 33.7% of the large AAAs would be captured, he said. Based on a score of 36 on the new model, the number of individuals who would need to be screened would be reduced to 6.3 million and nearly 59.3% of AAAs would be identified. “It would take 156 screenings with the current guidelines to get a single AAA, whereas it would take 85 screenings with our scoring system to find one person with AAA,” Dr. Greco said.

Alternatively, if the threshold were lowered to a score of 30, the same level of screening would bring the yield of detected AAAs to 84%, he added.

During a discussion of the findings, Dr. Sicard asked whether a separate scoring system should be developed for women, observing that the analysis contained very few women with large AAAs who were younger than 75 years. One attendee asked whether intervention should begin at a smaller aneurysm size in women, who present with rupture more often than do males and have greater in-hospital mortality. Dr. Greco said that a separate system for women would not be necessary, as they are included in the new model and the stringency of the test on smaller aneurysms is affected by lowering the score threshold. Ultimately, society would need to decide whether additional funds should be allocated to expand screening. A cost analysis is planned, Dr. Greco said in an interview.

Disclosures: Dr. Greco and Dr. Sicard disclosed no conflicts of interest. Dr. Kent has been an investigator on various industry-sponsored trials. A study coauthor disclosed employment with Life Line Screening of America.

It would take 156 screenings with the current guidelines to get a single AAA vs. 85 screenings with this system.

Source DR. GRECO

The risk of AAA fell dramatically for those who quit smoking.

Source DR. KENT

CHICAGO — Researchers have developed a simple scoring system that detects large abdominal aortic aneurysms in a broader at-risk population—including women and those younger than 65 years—than do current screening criteria.

Based on an analysis of 3.1 million patients, the new scoring system estimated the prevalence of 5-cm or greater abdominal aortic aneurysms (AAA) in the United States to be 0.14%, or equivalent to 120,810 aneurysms. The current U.S. Preventive Services Task Force (USPSTF) guidelines would capture just one-third of these large aneurysms, whereas two-thirds would be identified with the new system, principal investigator Giampaolo Greco, Ph.D., said at the annual meeting of the American Surgical Association.

“The score needs to be validated in another cohort, but if validated, we believe these results argue for fundamentally changing current screening policy,” he said.

Dr. Gregorio Sicard called the findings a “landmark in the area of screening for vascular disease.” Dr. Sicard, an invited discussant who is head of vascular surgery at Washington University in St. Louis, said that the current USPSTF guidelines have not been universally encouraged or adopted by vascular surgeons, and that utilization of Medicare's one-time ultrasound screening for AAA has been unsuccessful.

“Use of a strategy with this statistical model will significantly increase and clarify this controversy in which patients are best screened,” he said.

The current USPSTF guidelines, which are designed to identify aneurysms greater than 3 cm in males aged 65–75 years who have ever smoked, are both too narrow and too broad, explained Dr. Greco of the department of health evidence and policy at Mount Sinai School of Medicine, New York. They exclude women, who account for 33% of the 20,000 deaths each year from ruptured AAA, and those younger than 65 years, who account for 10% of AAA deaths. They also identify smaller AAAs that are at a lower risk of rupture, thereby resulting in unnecessary anxiety in low-risk individuals.

Dr. Greco and his associates used multivariate logistic regression analysis to identify risk factors for AAAs in 3.1 million patients undergoing ultrasound screening for AAA by Life Line Screening from 2003 to 2008. Not surprisingly, smoking was found to have a profound influence on the risk for a 5-cm or larger AAA; the risk increased with quantity and duration of smoking and decreased following smoking cessation. Odds ratios ranged from 2.6 for smoking a half-pack or less per day for less than 10 years to 14.5 for smoking more than a half-pack per day for 35 years. The risk of AAA fell dramatically for those who quit smoking for 5–10 years (OR 0.8) and for more than 10 years (OR 0.5), reported Dr. Greco and senior author Dr. K. Craig Kent, chair of the surgery department at the University of Wisconsin in Madison.

Others at elevated risk included males (OR 7.7), those with a family history of AAA (OR 3.2), and those aged 85 years or older (OR 53.1).

Novel findings included a protective effect of exercising at least once per week (OR 0.8), consuming nuts at least four times per week (OR 0.9), and being of black (OR 0.7) or Hispanic (OR 0.7) ethnicity, Dr. Greco said.

Using these and other factors, the researchers developed a scoring system with a good predictive accuracy, as noted by a C statistic equal to 0.81. If AAA screening were performed on the 6.8 million at-risk individuals identified by current screening criteria, 33.7% of the large AAAs would be captured, he said. Based on a score of 36 on the new model, the number of individuals who would need to be screened would be reduced to 6.3 million and nearly 59.3% of AAAs would be identified. “It would take 156 screenings with the current guidelines to get a single AAA, whereas it would take 85 screenings with our scoring system to find one person with AAA,” Dr. Greco said.

Alternatively, if the threshold were lowered to a score of 30, the same level of screening would bring the yield of detected AAAs to 84%, he added.

During a discussion of the findings, Dr. Sicard asked whether a separate scoring system should be developed for women, observing that the analysis contained very few women with large AAAs who were younger than 75 years. One attendee asked whether intervention should begin at a smaller aneurysm size in women, who present with rupture more often than do males and have greater in-hospital mortality. Dr. Greco said that a separate system for women would not be necessary, as they are included in the new model and the stringency of the test on smaller aneurysms is affected by lowering the score threshold. Ultimately, society would need to decide whether additional funds should be allocated to expand screening. A cost analysis is planned, Dr. Greco said in an interview.

Disclosures: Dr. Greco and Dr. Sicard disclosed no conflicts of interest. Dr. Kent has been an investigator on various industry-sponsored trials. A study coauthor disclosed employment with Life Line Screening of America.

It would take 156 screenings with the current guidelines to get a single AAA vs. 85 screenings with this system.

Source DR. GRECO

The risk of AAA fell dramatically for those who quit smoking.

Source DR. KENT

Major Finding: Depth of fetal zone enlargement was 58% in the 21 women who gave birth within 7 days of initial assessment, compared with 40% in the 41 women who were delivered more than 7 days after assessment, a significant difference.

Data Source: A prospective study of 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation.

Disclosures: The University of Maryland and Yale University provided support for the study. Dr. Turan disclosed no relevant conflicts of interest.

CHICAGO — A simple two-dimensional ultrasound measurement of the depth of the fetal adrenal gland zone enlargement is a better predictor of preterm birth than cervical length, and is able to predict preterm birth within 7 days, according to Dr. Ozhan Turan.

The 2-D measurement is also as accurate as 3-D ultrasonography, which is less widely available, more complex, and more time consuming, Dr. Turan reported at the annual meeting of the Society for Maternal-Fetal Medicine. “It is plausible that these observations are due to the fact that ultrasound measurement of the fetal zone provides a noninvasive tool to study an essential component of the physiology that initiates the preterm birth process,” he said. “If this can be confirmed, it holds great promise in the study and the management of preterm birth.”

The researchers previously showed that fetal adrenal gland volume using 3-D ultrasound was able to predict preterm birth within 5 days of assessment (Obstet. Gynecol. 2007;109:855-62). The fetal zone makes up the majority of the adrenal cortex in fetuses, but begins to disappear the first few days after birth.

In the current analysis, 3-D ultrasound with virtual organ computer-aided analysis technology was used to determine corrected adrenal gland volume, and 2-D ultrasound was used to measure the whole gland and fetal zone in singleton pregnancies, in 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation. The fetal zone to whole gland ratio was calculated as an index of the depth of fetal zone enlargement.

In the whole population, mean depth of fetal zone enlargement was 46%, mean corrected adrenal gland volume was 400 mm

Twenty-one women gave birth within 7 days of initial assessment and 41, more than 7 days after assessment. The depth of fetal zone enlargement was 58% in the group who were delivered within 7 days of initial assessment, compared with 40% in the group who were delivered more than 7 days after assessment. Adrenal gland volume was 553.5 mm

In receiver operating characteristic area under the curve analyses, the sensitivity and specificity of fetal zone depth was 100% and 88% in the earlier and later delivery groups, compared with 85% and 90% for adrenal gland volume and 56% and 57% for cervical length. For comparison, he noted that assuming a false-positive rate of 10%, the ability to predict preterm birth in clinical practice is just 18% for uterine contractions, 60% for cervical length, 50% for fetal fibronectin testing, 71% for combined cervical length and fetal fibronectin, and 82% for interleukin-6.

During a discussion of the study, attendees asked what impact steroids had on adrenal measurements and how much time 2-D ultrasound adds to an evaluation. Dr. Turan responded that there was no significant difference in adrenal volume 24 hours after second steroid administration, and that the method adds only a few minutes to an evaluation once the clinician is trained.

Major Finding: Depth of fetal zone enlargement was 58% in the 21 women who gave birth within 7 days of initial assessment, compared with 40% in the 41 women who were delivered more than 7 days after assessment, a significant difference.

Data Source: A prospective study of 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation.

Disclosures: The University of Maryland and Yale University provided support for the study. Dr. Turan disclosed no relevant conflicts of interest.

CHICAGO — A simple two-dimensional ultrasound measurement of the depth of the fetal adrenal gland zone enlargement is a better predictor of preterm birth than cervical length, and is able to predict preterm birth within 7 days, according to Dr. Ozhan Turan.

The 2-D measurement is also as accurate as 3-D ultrasonography, which is less widely available, more complex, and more time consuming, Dr. Turan reported at the annual meeting of the Society for Maternal-Fetal Medicine. “It is plausible that these observations are due to the fact that ultrasound measurement of the fetal zone provides a noninvasive tool to study an essential component of the physiology that initiates the preterm birth process,” he said. “If this can be confirmed, it holds great promise in the study and the management of preterm birth.”

The researchers previously showed that fetal adrenal gland volume using 3-D ultrasound was able to predict preterm birth within 5 days of assessment (Obstet. Gynecol. 2007;109:855-62). The fetal zone makes up the majority of the adrenal cortex in fetuses, but begins to disappear the first few days after birth.

In the current analysis, 3-D ultrasound with virtual organ computer-aided analysis technology was used to determine corrected adrenal gland volume, and 2-D ultrasound was used to measure the whole gland and fetal zone in singleton pregnancies, in 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation. The fetal zone to whole gland ratio was calculated as an index of the depth of fetal zone enlargement.

In the whole population, mean depth of fetal zone enlargement was 46%, mean corrected adrenal gland volume was 400 mm

Twenty-one women gave birth within 7 days of initial assessment and 41, more than 7 days after assessment. The depth of fetal zone enlargement was 58% in the group who were delivered within 7 days of initial assessment, compared with 40% in the group who were delivered more than 7 days after assessment. Adrenal gland volume was 553.5 mm

In receiver operating characteristic area under the curve analyses, the sensitivity and specificity of fetal zone depth was 100% and 88% in the earlier and later delivery groups, compared with 85% and 90% for adrenal gland volume and 56% and 57% for cervical length. For comparison, he noted that assuming a false-positive rate of 10%, the ability to predict preterm birth in clinical practice is just 18% for uterine contractions, 60% for cervical length, 50% for fetal fibronectin testing, 71% for combined cervical length and fetal fibronectin, and 82% for interleukin-6.

During a discussion of the study, attendees asked what impact steroids had on adrenal measurements and how much time 2-D ultrasound adds to an evaluation. Dr. Turan responded that there was no significant difference in adrenal volume 24 hours after second steroid administration, and that the method adds only a few minutes to an evaluation once the clinician is trained.

Major Finding: Depth of fetal zone enlargement was 58% in the 21 women who gave birth within 7 days of initial assessment, compared with 40% in the 41 women who were delivered more than 7 days after assessment, a significant difference.

Data Source: A prospective study of 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation.

Disclosures: The University of Maryland and Yale University provided support for the study. Dr. Turan disclosed no relevant conflicts of interest.

CHICAGO — A simple two-dimensional ultrasound measurement of the depth of the fetal adrenal gland zone enlargement is a better predictor of preterm birth than cervical length, and is able to predict preterm birth within 7 days, according to Dr. Ozhan Turan.

The 2-D measurement is also as accurate as 3-D ultrasonography, which is less widely available, more complex, and more time consuming, Dr. Turan reported at the annual meeting of the Society for Maternal-Fetal Medicine. “It is plausible that these observations are due to the fact that ultrasound measurement of the fetal zone provides a noninvasive tool to study an essential component of the physiology that initiates the preterm birth process,” he said. “If this can be confirmed, it holds great promise in the study and the management of preterm birth.”

The researchers previously showed that fetal adrenal gland volume using 3-D ultrasound was able to predict preterm birth within 5 days of assessment (Obstet. Gynecol. 2007;109:855-62). The fetal zone makes up the majority of the adrenal cortex in fetuses, but begins to disappear the first few days after birth.

In the current analysis, 3-D ultrasound with virtual organ computer-aided analysis technology was used to determine corrected adrenal gland volume, and 2-D ultrasound was used to measure the whole gland and fetal zone in singleton pregnancies, in 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation. The fetal zone to whole gland ratio was calculated as an index of the depth of fetal zone enlargement.

In the whole population, mean depth of fetal zone enlargement was 46%, mean corrected adrenal gland volume was 400 mm

Twenty-one women gave birth within 7 days of initial assessment and 41, more than 7 days after assessment. The depth of fetal zone enlargement was 58% in the group who were delivered within 7 days of initial assessment, compared with 40% in the group who were delivered more than 7 days after assessment. Adrenal gland volume was 553.5 mm

In receiver operating characteristic area under the curve analyses, the sensitivity and specificity of fetal zone depth was 100% and 88% in the earlier and later delivery groups, compared with 85% and 90% for adrenal gland volume and 56% and 57% for cervical length. For comparison, he noted that assuming a false-positive rate of 10%, the ability to predict preterm birth in clinical practice is just 18% for uterine contractions, 60% for cervical length, 50% for fetal fibronectin testing, 71% for combined cervical length and fetal fibronectin, and 82% for interleukin-6.

During a discussion of the study, attendees asked what impact steroids had on adrenal measurements and how much time 2-D ultrasound adds to an evaluation. Dr. Turan responded that there was no significant difference in adrenal volume 24 hours after second steroid administration, and that the method adds only a few minutes to an evaluation once the clinician is trained.

Major Finding: High-risk women with a U-shaped cervical funnel gave birth significantly earlier at 31.8 weeks' gestation, versus 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel.

Data Source: Secondary analysis of 301 women in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Mancuso disclosed no conflicts of interest.

CHICAGO — The presence of a U-shaped cervical funnel was significantly associated with earlier birth in high-risk women in a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

Women with a U-shaped funnel gave birth nearly 3 weeks earlier at a gestational age of 31.8 weeks, compared with 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel, Dr. Melissa Mancuso reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The relationship was independent of cervical length in the women, all of whom had a prior spontaneous preterm birth and a shortened midtrimester cervical length of less than 25 mm.

Women with a U-shaped funnel also were found to have the greatest benefit from cerclage. During a discussion of the study, one attendee asked if the findings suggest that the benefit of cerclage is only in women with a U-shaped funnel.

“What we know from the parent randomized trial is that there is a benefit from cerclage and that benefit increases as your cervical length decreases,” she said. “If there is a U funnel present, that benefit is increased further.”

It's been nearly 2 decades since researchers first described dilation and effacement in normal, term pregnancies as a progression of the funnel- or T-shaped internal cervical os to a Y shape, then a V shape, and finally a U shape (J. Ultrasound Med. 1995;14:719-24). While funneling has been found to be a risk factor for preterm birth in some reports, controversy lingers over its clinical utility and whether the clinical implications of a U- and V-shaped funnel are the same.

Dr. Mancuso reported on 301 women who were randomized to cerclage or no cerclage and underwent serial vaginal ultrasound between 16 and nearly 23 weeks, revealing no funnel in 154 women, a V-shaped funnel in 99, and a U-shaped funnel in 48. At baseline, women with a U funnel had a significantly shorter mean cervical length of 13 mm, compared with 19 mm for women with a V funnel and 21 mm for those with no funnel, said Dr. Mancuso of the University of Alabama at Birmingham. Twice as many women with a U funnel were treated with cerclage vs. no cerclage (32 vs. 16), which was a significant difference.

In a univariate analysis, the presence of a U funnel, but not a V funnel, was significantly associated with an increased risk of preterm birth at all four time points measured. Preterm birth rates in the U-funnel, V-funnel, and no-funnel groups were 23% vs. 6% vs. 8.4% at less than 24 weeks, 38% vs. 17% vs. 12% at less than 28 weeks, 60% vs. 34% vs. 32% at less than 35 weeks, and 73% vs. 50% vs. 47% at less than 37 weeks. There was no significant difference between the no-funnel and V-funnel groups.

After investigators controlled for baseline cervical length and cerclage, a U-shaped funnel remained significantly associated with preterm birth, with adjusted odds ratios ranging from 2.4 to 2.1, Dr. Mancuso said.

Because U-funnel outcomes appeared to be appreciably worse, the researchers investigated the possibility of an interaction between the U funnel and cerclage. Indeed, women with a U-shaped funnel gave birth a mean 4.9 weeks later in gestation with a cerclage than without a cerclage. This relationship remained significant, even after cervical length was controlled for, she said.

Session moderator Dr. Joshua Copel of Yale University in New Haven, Conn., described the findings as interesting and provocative.

Major Finding: High-risk women with a U-shaped cervical funnel gave birth significantly earlier at 31.8 weeks' gestation, versus 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel.

Data Source: Secondary analysis of 301 women in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Mancuso disclosed no conflicts of interest.

CHICAGO — The presence of a U-shaped cervical funnel was significantly associated with earlier birth in high-risk women in a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

Women with a U-shaped funnel gave birth nearly 3 weeks earlier at a gestational age of 31.8 weeks, compared with 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel, Dr. Melissa Mancuso reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The relationship was independent of cervical length in the women, all of whom had a prior spontaneous preterm birth and a shortened midtrimester cervical length of less than 25 mm.

Women with a U-shaped funnel also were found to have the greatest benefit from cerclage. During a discussion of the study, one attendee asked if the findings suggest that the benefit of cerclage is only in women with a U-shaped funnel.

“What we know from the parent randomized trial is that there is a benefit from cerclage and that benefit increases as your cervical length decreases,” she said. “If there is a U funnel present, that benefit is increased further.”

It's been nearly 2 decades since researchers first described dilation and effacement in normal, term pregnancies as a progression of the funnel- or T-shaped internal cervical os to a Y shape, then a V shape, and finally a U shape (J. Ultrasound Med. 1995;14:719-24). While funneling has been found to be a risk factor for preterm birth in some reports, controversy lingers over its clinical utility and whether the clinical implications of a U- and V-shaped funnel are the same.

Dr. Mancuso reported on 301 women who were randomized to cerclage or no cerclage and underwent serial vaginal ultrasound between 16 and nearly 23 weeks, revealing no funnel in 154 women, a V-shaped funnel in 99, and a U-shaped funnel in 48. At baseline, women with a U funnel had a significantly shorter mean cervical length of 13 mm, compared with 19 mm for women with a V funnel and 21 mm for those with no funnel, said Dr. Mancuso of the University of Alabama at Birmingham. Twice as many women with a U funnel were treated with cerclage vs. no cerclage (32 vs. 16), which was a significant difference.

In a univariate analysis, the presence of a U funnel, but not a V funnel, was significantly associated with an increased risk of preterm birth at all four time points measured. Preterm birth rates in the U-funnel, V-funnel, and no-funnel groups were 23% vs. 6% vs. 8.4% at less than 24 weeks, 38% vs. 17% vs. 12% at less than 28 weeks, 60% vs. 34% vs. 32% at less than 35 weeks, and 73% vs. 50% vs. 47% at less than 37 weeks. There was no significant difference between the no-funnel and V-funnel groups.

After investigators controlled for baseline cervical length and cerclage, a U-shaped funnel remained significantly associated with preterm birth, with adjusted odds ratios ranging from 2.4 to 2.1, Dr. Mancuso said.

Because U-funnel outcomes appeared to be appreciably worse, the researchers investigated the possibility of an interaction between the U funnel and cerclage. Indeed, women with a U-shaped funnel gave birth a mean 4.9 weeks later in gestation with a cerclage than without a cerclage. This relationship remained significant, even after cervical length was controlled for, she said.

Session moderator Dr. Joshua Copel of Yale University in New Haven, Conn., described the findings as interesting and provocative.

Major Finding: High-risk women with a U-shaped cervical funnel gave birth significantly earlier at 31.8 weeks' gestation, versus 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel.

Data Source: Secondary analysis of 301 women in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Mancuso disclosed no conflicts of interest.

CHICAGO — The presence of a U-shaped cervical funnel was significantly associated with earlier birth in high-risk women in a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

Women with a U-shaped funnel gave birth nearly 3 weeks earlier at a gestational age of 31.8 weeks, compared with 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel, Dr. Melissa Mancuso reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The relationship was independent of cervical length in the women, all of whom had a prior spontaneous preterm birth and a shortened midtrimester cervical length of less than 25 mm.

Women with a U-shaped funnel also were found to have the greatest benefit from cerclage. During a discussion of the study, one attendee asked if the findings suggest that the benefit of cerclage is only in women with a U-shaped funnel.

“What we know from the parent randomized trial is that there is a benefit from cerclage and that benefit increases as your cervical length decreases,” she said. “If there is a U funnel present, that benefit is increased further.”

It's been nearly 2 decades since researchers first described dilation and effacement in normal, term pregnancies as a progression of the funnel- or T-shaped internal cervical os to a Y shape, then a V shape, and finally a U shape (J. Ultrasound Med. 1995;14:719-24). While funneling has been found to be a risk factor for preterm birth in some reports, controversy lingers over its clinical utility and whether the clinical implications of a U- and V-shaped funnel are the same.

Dr. Mancuso reported on 301 women who were randomized to cerclage or no cerclage and underwent serial vaginal ultrasound between 16 and nearly 23 weeks, revealing no funnel in 154 women, a V-shaped funnel in 99, and a U-shaped funnel in 48. At baseline, women with a U funnel had a significantly shorter mean cervical length of 13 mm, compared with 19 mm for women with a V funnel and 21 mm for those with no funnel, said Dr. Mancuso of the University of Alabama at Birmingham. Twice as many women with a U funnel were treated with cerclage vs. no cerclage (32 vs. 16), which was a significant difference.

In a univariate analysis, the presence of a U funnel, but not a V funnel, was significantly associated with an increased risk of preterm birth at all four time points measured. Preterm birth rates in the U-funnel, V-funnel, and no-funnel groups were 23% vs. 6% vs. 8.4% at less than 24 weeks, 38% vs. 17% vs. 12% at less than 28 weeks, 60% vs. 34% vs. 32% at less than 35 weeks, and 73% vs. 50% vs. 47% at less than 37 weeks. There was no significant difference between the no-funnel and V-funnel groups.

After investigators controlled for baseline cervical length and cerclage, a U-shaped funnel remained significantly associated with preterm birth, with adjusted odds ratios ranging from 2.4 to 2.1, Dr. Mancuso said.

Because U-funnel outcomes appeared to be appreciably worse, the researchers investigated the possibility of an interaction between the U funnel and cerclage. Indeed, women with a U-shaped funnel gave birth a mean 4.9 weeks later in gestation with a cerclage than without a cerclage. This relationship remained significant, even after cervical length was controlled for, she said.

Session moderator Dr. Joshua Copel of Yale University in New Haven, Conn., described the findings as interesting and provocative.

Major Finding: In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18). There was no significant effect of 17P in women with a cervical length of less than 15 mm.

Data Source: Secondary analysis of 300 patients in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Berghella disclosed no conflicts of interest.

CHICAGO — The effect of 17-alpha-hydroxyprogesterone caproate on preterm birth varies depending on the presence or absence of cerclage in high-risk women, according to a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

In women with prior spontaneous preterm birth and a cervical length of less than 25 mm, the hormone had no effect if cerclage was present, but significantly reduced preterm births at less than 24 weeks and perinatal mortality if cerclage was absent, Dr. Vincenzo Berghella reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The use of 17-alpha-hydroxyprogesterone caproate (17P) had no effect on the primary outcome of preterm birth at less than 35 weeks in either the cerclage or no-cerclage groups.

Among the 148 women randomized to cerclage, the primary outcome occurred in 30% of the 47 women receiving 17P and in 34% of the 101 women with no 17P (odds ratio, 0.84).

Among the 152 women with no cerclage, the primary outcome occurred in 39% of the 52 women who received 17P and in 44% of the 100 women with no 17P (OR, 0.80). Women given 17P in either group received an average of 11 injections, beginning at an average gestational age of 18-19 weeks (range, 16-28 weeks).

In the presence of cerclage, the use of 17P had no significant effect on the outcomes of preterm birth at less than 24 weeks (OR, 0.60); less than 28 weeks (OR, 0.46); less than 32 weeks (OR, 0.62); or less than 37 weeks (OR, 1.29). The use of 17P in the presence of cerclage also had no significant effect on perinatal death (OR, 0.62), said Dr. Berghella, professor of ob.gyn. at Jefferson Medical College in Philadelphia.

In the absence of cerclage, the use of 17P had a significant effect only on preterm birth at less than 24 weeks, occurring in 2% of women given 17P vs. 20% with no 17P (OR, 0.08), and on perinatal death, occurring in 4% of women given 17P and 23% with no 17P (OR, 0.14).

Because cervical length was a significant predictor of preterm birth in both groups in a logistic regression analysis, the researchers analyzed the effect of 17P using different cervical length cutoffs. In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18), while there was no significant effect of 17P in women with a cervical length of less than 15 mm, Dr. Berghella said.

During a discussion of the findings, an attendee said the study provides a clear clinical effect of 17P, but that the researchers may have “de-powered” the study by separately analyzing the women based on cerclage status. Dr. Berghella said the researchers felt that women who receive cerclage are different from those who do not, and that the design was influenced by the original analysis showing that cerclage had an influence on preterm birth (Am. J. Obstet. Gynecol. 2009;201:375:e1-8).

Major Finding: In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18). There was no significant effect of 17P in women with a cervical length of less than 15 mm.

Data Source: Secondary analysis of 300 patients in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Berghella disclosed no conflicts of interest.

CHICAGO — The effect of 17-alpha-hydroxyprogesterone caproate on preterm birth varies depending on the presence or absence of cerclage in high-risk women, according to a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

In women with prior spontaneous preterm birth and a cervical length of less than 25 mm, the hormone had no effect if cerclage was present, but significantly reduced preterm births at less than 24 weeks and perinatal mortality if cerclage was absent, Dr. Vincenzo Berghella reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The use of 17-alpha-hydroxyprogesterone caproate (17P) had no effect on the primary outcome of preterm birth at less than 35 weeks in either the cerclage or no-cerclage groups.

Among the 148 women randomized to cerclage, the primary outcome occurred in 30% of the 47 women receiving 17P and in 34% of the 101 women with no 17P (odds ratio, 0.84).

Among the 152 women with no cerclage, the primary outcome occurred in 39% of the 52 women who received 17P and in 44% of the 100 women with no 17P (OR, 0.80). Women given 17P in either group received an average of 11 injections, beginning at an average gestational age of 18-19 weeks (range, 16-28 weeks).

In the presence of cerclage, the use of 17P had no significant effect on the outcomes of preterm birth at less than 24 weeks (OR, 0.60); less than 28 weeks (OR, 0.46); less than 32 weeks (OR, 0.62); or less than 37 weeks (OR, 1.29). The use of 17P in the presence of cerclage also had no significant effect on perinatal death (OR, 0.62), said Dr. Berghella, professor of ob.gyn. at Jefferson Medical College in Philadelphia.

In the absence of cerclage, the use of 17P had a significant effect only on preterm birth at less than 24 weeks, occurring in 2% of women given 17P vs. 20% with no 17P (OR, 0.08), and on perinatal death, occurring in 4% of women given 17P and 23% with no 17P (OR, 0.14).

Because cervical length was a significant predictor of preterm birth in both groups in a logistic regression analysis, the researchers analyzed the effect of 17P using different cervical length cutoffs. In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18), while there was no significant effect of 17P in women with a cervical length of less than 15 mm, Dr. Berghella said.

During a discussion of the findings, an attendee said the study provides a clear clinical effect of 17P, but that the researchers may have “de-powered” the study by separately analyzing the women based on cerclage status. Dr. Berghella said the researchers felt that women who receive cerclage are different from those who do not, and that the design was influenced by the original analysis showing that cerclage had an influence on preterm birth (Am. J. Obstet. Gynecol. 2009;201:375:e1-8).

Major Finding: In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18). There was no significant effect of 17P in women with a cervical length of less than 15 mm.

Data Source: Secondary analysis of 300 patients in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Berghella disclosed no conflicts of interest.

CHICAGO — The effect of 17-alpha-hydroxyprogesterone caproate on preterm birth varies depending on the presence or absence of cerclage in high-risk women, according to a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

In women with prior spontaneous preterm birth and a cervical length of less than 25 mm, the hormone had no effect if cerclage was present, but significantly reduced preterm births at less than 24 weeks and perinatal mortality if cerclage was absent, Dr. Vincenzo Berghella reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The use of 17-alpha-hydroxyprogesterone caproate (17P) had no effect on the primary outcome of preterm birth at less than 35 weeks in either the cerclage or no-cerclage groups.

Among the 148 women randomized to cerclage, the primary outcome occurred in 30% of the 47 women receiving 17P and in 34% of the 101 women with no 17P (odds ratio, 0.84).

Among the 152 women with no cerclage, the primary outcome occurred in 39% of the 52 women who received 17P and in 44% of the 100 women with no 17P (OR, 0.80). Women given 17P in either group received an average of 11 injections, beginning at an average gestational age of 18-19 weeks (range, 16-28 weeks).

In the presence of cerclage, the use of 17P had no significant effect on the outcomes of preterm birth at less than 24 weeks (OR, 0.60); less than 28 weeks (OR, 0.46); less than 32 weeks (OR, 0.62); or less than 37 weeks (OR, 1.29). The use of 17P in the presence of cerclage also had no significant effect on perinatal death (OR, 0.62), said Dr. Berghella, professor of ob.gyn. at Jefferson Medical College in Philadelphia.

In the absence of cerclage, the use of 17P had a significant effect only on preterm birth at less than 24 weeks, occurring in 2% of women given 17P vs. 20% with no 17P (OR, 0.08), and on perinatal death, occurring in 4% of women given 17P and 23% with no 17P (OR, 0.14).

Because cervical length was a significant predictor of preterm birth in both groups in a logistic regression analysis, the researchers analyzed the effect of 17P using different cervical length cutoffs. In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18), while there was no significant effect of 17P in women with a cervical length of less than 15 mm, Dr. Berghella said.

During a discussion of the findings, an attendee said the study provides a clear clinical effect of 17P, but that the researchers may have “de-powered” the study by separately analyzing the women based on cerclage status. Dr. Berghella said the researchers felt that women who receive cerclage are different from those who do not, and that the design was influenced by the original analysis showing that cerclage had an influence on preterm birth (Am. J. Obstet. Gynecol. 2009;201:375:e1-8).

Major Finding: A test based on five marker proteins in cervicovaginal fluid was able to discriminate intra-amniotic infection in 13 of 14 cases in which infection was present and in 7 of 84 in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

Data Source: Multicenter trial involving 105 women with preterm labor.

Disclosures: Dr. Combs has received honorarium from ProteoGenix Inc., the sponsor of the study.

CHICAGO — A noninvasive test that discriminates between the presence and absence of intra-amniotic infection in women with preterm labor could reduce the need for amniocentesis in this population, according to Dr. C. Andrew Combs.

The test, based on five distinct proteins in cervicovaginal fluid, also may be useful in the management of preterm labor, which is dependent on infection status. Antibiotics and prompt delivery are indicated when infection is present, while tocolysis and prenatal steroids are used when it is absent, he said at the annual meeting of the Society for Maternal-Fetal Medicine.

Amniocentesis is often needed to make an accurate diagnosis of intra-amniotic infection (IAI), but is frequently refused by women in preterm labor because of the associated risk of miscarriage. Even when amniocentesis is used, rapid results are somewhat limited, said Dr. Combs, a perinatalogist in group practice in Campbell, Calif.

IAI is subclinical in 80% of cases, and clinical signs such as fever, uterine tenderness, white blood count, and tachycardia are often absent. A culture takes 2-5 days and is negative in up to one-third of IAI cases, he said. Finally, cultures specific for Mycoplasma and Ureaplasma species, which may be important in many of these infections, are not available in most hospital laboratories.

Dr. Combs and his associates hypothesized that proteins in cervicovaginal fluid would be differentially expressed in infected vs. noninfected cases, and tested this hypothesis in a multicenter trial involving 105 women with preterm labor at a gestational age of more than 22 weeks with intact membranes. IAI was present in 14 (13%) based on a positive amniocentesis fluid culture and/or 16S ribosomal DNA polymerase chain reaction test result. Cervicovaginal swabs were used for protein analysis.

Screening was performed on 178 proteins likely to have an association with IAI, with 42 entered into statistical models. Five proteins were included in a final model: one plasma protein, two cytokine/chemokines, one cell adhesion protein, and one peroxidase. Dr. Combs declined to specifically identify the proteins, citing proprietary reasons on behalf of ProteoGenix Inc. (Costa Mesa, Calif.), which sponsored the study and is developing a commercial test.

The final model had a “mediocre” area under the receiver operating characteristic curve of 0.84 with only a single protein, improving to 0.94 with three proteins and to 0.98 with all five proteins, Dr. Combs said. The five-marker test was positive in 13 of 14 cases in which infection was present and in 7 of 84 cases in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

“We think this is an excellent diagnostic performance,” he said.

An audience member expressed concern about using a test with such a low positive predictive value. Dr. Combs said he shared this skepticism if the test were used as the basis for prescribing antibiotics and delivering the infant in a mother with an intra-amniotic infection. He added that he would use a positive result to direct him to perform amniocentesis.

Validation of the test is underway in an independent population, with 300 patients already enrolled, he said.

Major Finding: A test based on five marker proteins in cervicovaginal fluid was able to discriminate intra-amniotic infection in 13 of 14 cases in which infection was present and in 7 of 84 in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

Data Source: Multicenter trial involving 105 women with preterm labor.

Disclosures: Dr. Combs has received honorarium from ProteoGenix Inc., the sponsor of the study.

CHICAGO — A noninvasive test that discriminates between the presence and absence of intra-amniotic infection in women with preterm labor could reduce the need for amniocentesis in this population, according to Dr. C. Andrew Combs.

The test, based on five distinct proteins in cervicovaginal fluid, also may be useful in the management of preterm labor, which is dependent on infection status. Antibiotics and prompt delivery are indicated when infection is present, while tocolysis and prenatal steroids are used when it is absent, he said at the annual meeting of the Society for Maternal-Fetal Medicine.

Amniocentesis is often needed to make an accurate diagnosis of intra-amniotic infection (IAI), but is frequently refused by women in preterm labor because of the associated risk of miscarriage. Even when amniocentesis is used, rapid results are somewhat limited, said Dr. Combs, a perinatalogist in group practice in Campbell, Calif.

IAI is subclinical in 80% of cases, and clinical signs such as fever, uterine tenderness, white blood count, and tachycardia are often absent. A culture takes 2-5 days and is negative in up to one-third of IAI cases, he said. Finally, cultures specific for Mycoplasma and Ureaplasma species, which may be important in many of these infections, are not available in most hospital laboratories.

Dr. Combs and his associates hypothesized that proteins in cervicovaginal fluid would be differentially expressed in infected vs. noninfected cases, and tested this hypothesis in a multicenter trial involving 105 women with preterm labor at a gestational age of more than 22 weeks with intact membranes. IAI was present in 14 (13%) based on a positive amniocentesis fluid culture and/or 16S ribosomal DNA polymerase chain reaction test result. Cervicovaginal swabs were used for protein analysis.

Screening was performed on 178 proteins likely to have an association with IAI, with 42 entered into statistical models. Five proteins were included in a final model: one plasma protein, two cytokine/chemokines, one cell adhesion protein, and one peroxidase. Dr. Combs declined to specifically identify the proteins, citing proprietary reasons on behalf of ProteoGenix Inc. (Costa Mesa, Calif.), which sponsored the study and is developing a commercial test.

The final model had a “mediocre” area under the receiver operating characteristic curve of 0.84 with only a single protein, improving to 0.94 with three proteins and to 0.98 with all five proteins, Dr. Combs said. The five-marker test was positive in 13 of 14 cases in which infection was present and in 7 of 84 cases in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

“We think this is an excellent diagnostic performance,” he said.

An audience member expressed concern about using a test with such a low positive predictive value. Dr. Combs said he shared this skepticism if the test were used as the basis for prescribing antibiotics and delivering the infant in a mother with an intra-amniotic infection. He added that he would use a positive result to direct him to perform amniocentesis.

Validation of the test is underway in an independent population, with 300 patients already enrolled, he said.

Major Finding: A test based on five marker proteins in cervicovaginal fluid was able to discriminate intra-amniotic infection in 13 of 14 cases in which infection was present and in 7 of 84 in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

Data Source: Multicenter trial involving 105 women with preterm labor.

Disclosures: Dr. Combs has received honorarium from ProteoGenix Inc., the sponsor of the study.

CHICAGO — A noninvasive test that discriminates between the presence and absence of intra-amniotic infection in women with preterm labor could reduce the need for amniocentesis in this population, according to Dr. C. Andrew Combs.

The test, based on five distinct proteins in cervicovaginal fluid, also may be useful in the management of preterm labor, which is dependent on infection status. Antibiotics and prompt delivery are indicated when infection is present, while tocolysis and prenatal steroids are used when it is absent, he said at the annual meeting of the Society for Maternal-Fetal Medicine.

Amniocentesis is often needed to make an accurate diagnosis of intra-amniotic infection (IAI), but is frequently refused by women in preterm labor because of the associated risk of miscarriage. Even when amniocentesis is used, rapid results are somewhat limited, said Dr. Combs, a perinatalogist in group practice in Campbell, Calif.

IAI is subclinical in 80% of cases, and clinical signs such as fever, uterine tenderness, white blood count, and tachycardia are often absent. A culture takes 2-5 days and is negative in up to one-third of IAI cases, he said. Finally, cultures specific for Mycoplasma and Ureaplasma species, which may be important in many of these infections, are not available in most hospital laboratories.

Dr. Combs and his associates hypothesized that proteins in cervicovaginal fluid would be differentially expressed in infected vs. noninfected cases, and tested this hypothesis in a multicenter trial involving 105 women with preterm labor at a gestational age of more than 22 weeks with intact membranes. IAI was present in 14 (13%) based on a positive amniocentesis fluid culture and/or 16S ribosomal DNA polymerase chain reaction test result. Cervicovaginal swabs were used for protein analysis.

Screening was performed on 178 proteins likely to have an association with IAI, with 42 entered into statistical models. Five proteins were included in a final model: one plasma protein, two cytokine/chemokines, one cell adhesion protein, and one peroxidase. Dr. Combs declined to specifically identify the proteins, citing proprietary reasons on behalf of ProteoGenix Inc. (Costa Mesa, Calif.), which sponsored the study and is developing a commercial test.

The final model had a “mediocre” area under the receiver operating characteristic curve of 0.84 with only a single protein, improving to 0.94 with three proteins and to 0.98 with all five proteins, Dr. Combs said. The five-marker test was positive in 13 of 14 cases in which infection was present and in 7 of 84 cases in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

“We think this is an excellent diagnostic performance,” he said.

An audience member expressed concern about using a test with such a low positive predictive value. Dr. Combs said he shared this skepticism if the test were used as the basis for prescribing antibiotics and delivering the infant in a mother with an intra-amniotic infection. He added that he would use a positive result to direct him to perform amniocentesis.

Validation of the test is underway in an independent population, with 300 patients already enrolled, he said.

Major Finding: A new screening tool could increase identification of large abdominal aortic aneurysms from 33.7% to 59.3%.

Data Source: Analysis of 3.1 million patients undergoing ultrasound screening for abdominal aortic aneurysms by Life Line Screening.

Disclosures: Dr. Greco and Dr. Sicard disclosed no conflicts of interest. A study coauthor disclosed employment with Life Line Screening of America.

CHICAGO — Researchers have developed a simple scoring system that detects large abdominal aortic aneurysms in a broader at-risk population—including women and those younger than 65 years—than do current screening criteria.

Based on an analysis of 3.1 million patients, the new scoring system estimated the prevalence of 5-cm or greater abdominal aortic aneurysms (AAA) in the United States to be 0.14%, or equivalent to 120,810 aneurysms. The current U.S. Preventive Services Task Force (USPSTF) guidelines would capture just one-third of these large aneurysms, whereas two-thirds would be identified with the new system, principal investigator Giampaolo Greco, Ph.D., said at the annual meeting of the American Surgical Association.

“The score needs to be validated in another cohort, but if validated, we believe these results argue for fundamentally changing current screening policy,” he said.

Dr. Gregorio Sicard called the findings a “landmark in the area of screening for vascular disease.” Dr. Sicard, an invited discussant who is head of vascular surgery at Washington University in St. Louis, said that the current USPSTF guidelines have not been universally encouraged or adopted by vascular surgeons, and that utilization of Medicare's one-time ultrasound screening for AAA has been unsuccessful.

“Use of a strategy with this statistical model will significantly increase and clarify this controversy in which patients are best screened,” he said.

The current USPSTF guidelines, which are designed to identify aneurysms greater than 3 cm in males aged 65-75 years who have ever smoked, are both too narrow and too broad, explained Dr. Greco of the department of health evidence and policy at Mount Sinai School of Medicine, New York. They exclude women, who account for 33% of the 20,000 deaths each year from ruptured AAA, and those younger than 65 years, who account for 10% of AAA deaths. They also identify smaller AAAs that are at a lower risk of rupture, thereby resulting in unnecessary anxiety in low-risk individuals.

Dr. Greco and his associates used multivariate logistic regression analysis to identify risk factors for AAAs in 3.1 million patients undergoing ultrasound screening for AAA by Life Line Screening from 2003 to 2008. Not surprisingly, smoking was found to have a profound influence on the risk for a 5-cm or larger AAA; the risk increased with quantity and duration of smoking and decreased following smoking cessation. Odds ratios ranged from 2.6 for smoking a half-pack or less per day for less than 10 years to 14.5 for smoking more than a half-pack per day for 35 years. The risk of AAA fell dramatically for those who quit smoking for 5-10 years (OR, 0.8) and for more than 10 years (OR, 0.5), reported Dr. Greco and senior author Dr. K. Craig Kent, chair of the surgery department at the University of Wisconsin in Madison.

Others at elevated risk included males (OR, 7.7), those with a family history of AAA (OR, 3.2), and those aged 85 years or older (OR, 53.1).

Novel findings included a protective effect of exercising at least once per week (OR, 0.8), consuming nuts at least four times per week (OR, 0.9), and being of black (OR, 0.7) or Hispanic (OR, 0.7) ethnicity, Dr. Greco said.

Using these and other factors, the researchers developed a scoring system with a good predictive accuracy, as noted by a C statistic equal to 0.81. If AAA screening were performed on the 6.8 million at-risk individuals identified by current screening criteria, 33.7% of the large AAAs would be captured, he said.

Based on a score of 36 on the new model, the number of individuals who would need to be screened would be reduced to 6.3 million and the number of identified AAAs would nearly double to 59.3%.

“It would take 156 screenings with the current guidelines to get a single AAA, whereas it would take 85 screenings with our scoring system to find one person with AAA,” Dr. Greco said.

Alternatively, if the threshold were lowered to a score of 30, the same level of screening would bring the yield of detected AAAs to 84%, he added.

During a discussion of the findings, Dr. Sicard asked whether a separate scoring system should be developed for women, observing that the analysis contained very few women with large AAAs who were younger than 75 years.

One attendee asked whether intervention should begin at a smaller aneurysm size in women, who present with rupture more often than do males and have greater in-hospital mortality. Dr. Greco said that a separate system for women would not be necessary, as they are included in the new model and the stringency of the test on smaller aneurysms is affected by lowering the score threshold.

Ultimately, society would need to decide whether additional funds should be allocated to expand screening to women and younger persons. A cost analysis was not performed at the time of the analysis, but is being planned, Dr. Greco said in an interview.

Several audience members questioned how best to distribute the new scoring system to the public and encourage them to get screened. One attendee suggested that the AAA risk form could be sent to the estimated 40 million members of the AARP.

It would take 156 screenings with the current guidelines to get a single AAA, versus 85 with the scoring system.

Source DR. GRECO

My Take

Waiting for Randomized Trials

Dr. Greco and his colleagues correctly point out that this scoring system needs to be prospectively validated before it can be used. This is particularly important when the data set is not all comers that arrive in our day to day practice, but those who specifically have sought out screening. This creates a selection bias.

If the authors are able to validate the scoring system, the next question becomes “Does the screening make a difference in outcomes?” The reason the current U.S. Preventive Services Task Force guidelines do not recommend screening in women is because screening studies have not demonstrated an improved outcome in women screened for AAA compared to those not screened.

Before this scoring tool is used in practice, it needs to be prospectively tested in a randomized controlled trial demonstrating that it helps improve patient outcomes, and it should be compared in some fashion to the current guideline. I have plenty to do already trying to manage the 30%-plus of the population who is obese, let alone trying to ferret out conditions that affect 0.14% of the population, when I don't know that finding them with a new screening tool will change outcomes.

PAUL OGDEN, M.D., M.S.P.H., is a family physician in private practice in Denver. He practices age management medicine and consults in preventive medicine. He served on the development team for Kaiser Permanente's current AAA screening clinical practice guideline.

Major Finding: A new screening tool could increase identification of large abdominal aortic aneurysms from 33.7% to 59.3%.

Data Source: Analysis of 3.1 million patients undergoing ultrasound screening for abdominal aortic aneurysms by Life Line Screening.

Disclosures: Dr. Greco and Dr. Sicard disclosed no conflicts of interest. A study coauthor disclosed employment with Life Line Screening of America.

CHICAGO — Researchers have developed a simple scoring system that detects large abdominal aortic aneurysms in a broader at-risk population—including women and those younger than 65 years—than do current screening criteria.

Based on an analysis of 3.1 million patients, the new scoring system estimated the prevalence of 5-cm or greater abdominal aortic aneurysms (AAA) in the United States to be 0.14%, or equivalent to 120,810 aneurysms. The current U.S. Preventive Services Task Force (USPSTF) guidelines would capture just one-third of these large aneurysms, whereas two-thirds would be identified with the new system, principal investigator Giampaolo Greco, Ph.D., said at the annual meeting of the American Surgical Association.

“The score needs to be validated in another cohort, but if validated, we believe these results argue for fundamentally changing current screening policy,” he said.

Dr. Gregorio Sicard called the findings a “landmark in the area of screening for vascular disease.” Dr. Sicard, an invited discussant who is head of vascular surgery at Washington University in St. Louis, said that the current USPSTF guidelines have not been universally encouraged or adopted by vascular surgeons, and that utilization of Medicare's one-time ultrasound screening for AAA has been unsuccessful.

“Use of a strategy with this statistical model will significantly increase and clarify this controversy in which patients are best screened,” he said.

The current USPSTF guidelines, which are designed to identify aneurysms greater than 3 cm in males aged 65-75 years who have ever smoked, are both too narrow and too broad, explained Dr. Greco of the department of health evidence and policy at Mount Sinai School of Medicine, New York. They exclude women, who account for 33% of the 20,000 deaths each year from ruptured AAA, and those younger than 65 years, who account for 10% of AAA deaths. They also identify smaller AAAs that are at a lower risk of rupture, thereby resulting in unnecessary anxiety in low-risk individuals.

Dr. Greco and his associates used multivariate logistic regression analysis to identify risk factors for AAAs in 3.1 million patients undergoing ultrasound screening for AAA by Life Line Screening from 2003 to 2008. Not surprisingly, smoking was found to have a profound influence on the risk for a 5-cm or larger AAA; the risk increased with quantity and duration of smoking and decreased following smoking cessation. Odds ratios ranged from 2.6 for smoking a half-pack or less per day for less than 10 years to 14.5 for smoking more than a half-pack per day for 35 years. The risk of AAA fell dramatically for those who quit smoking for 5-10 years (OR, 0.8) and for more than 10 years (OR, 0.5), reported Dr. Greco and senior author Dr. K. Craig Kent, chair of the surgery department at the University of Wisconsin in Madison.

Others at elevated risk included males (OR, 7.7), those with a family history of AAA (OR, 3.2), and those aged 85 years or older (OR, 53.1).

Novel findings included a protective effect of exercising at least once per week (OR, 0.8), consuming nuts at least four times per week (OR, 0.9), and being of black (OR, 0.7) or Hispanic (OR, 0.7) ethnicity, Dr. Greco said.

Using these and other factors, the researchers developed a scoring system with a good predictive accuracy, as noted by a C statistic equal to 0.81. If AAA screening were performed on the 6.8 million at-risk individuals identified by current screening criteria, 33.7% of the large AAAs would be captured, he said.

Based on a score of 36 on the new model, the number of individuals who would need to be screened would be reduced to 6.3 million and the number of identified AAAs would nearly double to 59.3%.

“It would take 156 screenings with the current guidelines to get a single AAA, whereas it would take 85 screenings with our scoring system to find one person with AAA,” Dr. Greco said.

Alternatively, if the threshold were lowered to a score of 30, the same level of screening would bring the yield of detected AAAs to 84%, he added.

During a discussion of the findings, Dr. Sicard asked whether a separate scoring system should be developed for women, observing that the analysis contained very few women with large AAAs who were younger than 75 years.

One attendee asked whether intervention should begin at a smaller aneurysm size in women, who present with rupture more often than do males and have greater in-hospital mortality. Dr. Greco said that a separate system for women would not be necessary, as they are included in the new model and the stringency of the test on smaller aneurysms is affected by lowering the score threshold.

Ultimately, society would need to decide whether additional funds should be allocated to expand screening to women and younger persons. A cost analysis was not performed at the time of the analysis, but is being planned, Dr. Greco said in an interview.

Several audience members questioned how best to distribute the new scoring system to the public and encourage them to get screened. One attendee suggested that the AAA risk form could be sent to the estimated 40 million members of the AARP.

It would take 156 screenings with the current guidelines to get a single AAA, versus 85 with the scoring system.

Source DR. GRECO

My Take

Waiting for Randomized Trials

Dr. Greco and his colleagues correctly point out that this scoring system needs to be prospectively validated before it can be used. This is particularly important when the data set is not all comers that arrive in our day to day practice, but those who specifically have sought out screening. This creates a selection bias.

If the authors are able to validate the scoring system, the next question becomes “Does the screening make a difference in outcomes?” The reason the current U.S. Preventive Services Task Force guidelines do not recommend screening in women is because screening studies have not demonstrated an improved outcome in women screened for AAA compared to those not screened.

Before this scoring tool is used in practice, it needs to be prospectively tested in a randomized controlled trial demonstrating that it helps improve patient outcomes, and it should be compared in some fashion to the current guideline. I have plenty to do already trying to manage the 30%-plus of the population who is obese, let alone trying to ferret out conditions that affect 0.14% of the population, when I don't know that finding them with a new screening tool will change outcomes.

PAUL OGDEN, M.D., M.S.P.H., is a family physician in private practice in Denver. He practices age management medicine and consults in preventive medicine. He served on the development team for Kaiser Permanente's current AAA screening clinical practice guideline.

Major Finding: A new screening tool could increase identification of large abdominal aortic aneurysms from 33.7% to 59.3%.

Data Source: Analysis of 3.1 million patients undergoing ultrasound screening for abdominal aortic aneurysms by Life Line Screening.

Disclosures: Dr. Greco and Dr. Sicard disclosed no conflicts of interest. A study coauthor disclosed employment with Life Line Screening of America.

CHICAGO — Researchers have developed a simple scoring system that detects large abdominal aortic aneurysms in a broader at-risk population—including women and those younger than 65 years—than do current screening criteria.

Based on an analysis of 3.1 million patients, the new scoring system estimated the prevalence of 5-cm or greater abdominal aortic aneurysms (AAA) in the United States to be 0.14%, or equivalent to 120,810 aneurysms. The current U.S. Preventive Services Task Force (USPSTF) guidelines would capture just one-third of these large aneurysms, whereas two-thirds would be identified with the new system, principal investigator Giampaolo Greco, Ph.D., said at the annual meeting of the American Surgical Association.

“The score needs to be validated in another cohort, but if validated, we believe these results argue for fundamentally changing current screening policy,” he said.

Dr. Gregorio Sicard called the findings a “landmark in the area of screening for vascular disease.” Dr. Sicard, an invited discussant who is head of vascular surgery at Washington University in St. Louis, said that the current USPSTF guidelines have not been universally encouraged or adopted by vascular surgeons, and that utilization of Medicare's one-time ultrasound screening for AAA has been unsuccessful.

“Use of a strategy with this statistical model will significantly increase and clarify this controversy in which patients are best screened,” he said.

The current USPSTF guidelines, which are designed to identify aneurysms greater than 3 cm in males aged 65-75 years who have ever smoked, are both too narrow and too broad, explained Dr. Greco of the department of health evidence and policy at Mount Sinai School of Medicine, New York. They exclude women, who account for 33% of the 20,000 deaths each year from ruptured AAA, and those younger than 65 years, who account for 10% of AAA deaths. They also identify smaller AAAs that are at a lower risk of rupture, thereby resulting in unnecessary anxiety in low-risk individuals.

Dr. Greco and his associates used multivariate logistic regression analysis to identify risk factors for AAAs in 3.1 million patients undergoing ultrasound screening for AAA by Life Line Screening from 2003 to 2008. Not surprisingly, smoking was found to have a profound influence on the risk for a 5-cm or larger AAA; the risk increased with quantity and duration of smoking and decreased following smoking cessation. Odds ratios ranged from 2.6 for smoking a half-pack or less per day for less than 10 years to 14.5 for smoking more than a half-pack per day for 35 years. The risk of AAA fell dramatically for those who quit smoking for 5-10 years (OR, 0.8) and for more than 10 years (OR, 0.5), reported Dr. Greco and senior author Dr. K. Craig Kent, chair of the surgery department at the University of Wisconsin in Madison.

Others at elevated risk included males (OR, 7.7), those with a family history of AAA (OR, 3.2), and those aged 85 years or older (OR, 53.1).

Novel findings included a protective effect of exercising at least once per week (OR, 0.8), consuming nuts at least four times per week (OR, 0.9), and being of black (OR, 0.7) or Hispanic (OR, 0.7) ethnicity, Dr. Greco said.

Using these and other factors, the researchers developed a scoring system with a good predictive accuracy, as noted by a C statistic equal to 0.81. If AAA screening were performed on the 6.8 million at-risk individuals identified by current screening criteria, 33.7% of the large AAAs would be captured, he said.

Based on a score of 36 on the new model, the number of individuals who would need to be screened would be reduced to 6.3 million and the number of identified AAAs would nearly double to 59.3%.

“It would take 156 screenings with the current guidelines to get a single AAA, whereas it would take 85 screenings with our scoring system to find one person with AAA,” Dr. Greco said.

Alternatively, if the threshold were lowered to a score of 30, the same level of screening would bring the yield of detected AAAs to 84%, he added.

During a discussion of the findings, Dr. Sicard asked whether a separate scoring system should be developed for women, observing that the analysis contained very few women with large AAAs who were younger than 75 years.

One attendee asked whether intervention should begin at a smaller aneurysm size in women, who present with rupture more often than do males and have greater in-hospital mortality. Dr. Greco said that a separate system for women would not be necessary, as they are included in the new model and the stringency of the test on smaller aneurysms is affected by lowering the score threshold.

Ultimately, society would need to decide whether additional funds should be allocated to expand screening to women and younger persons. A cost analysis was not performed at the time of the analysis, but is being planned, Dr. Greco said in an interview.

Several audience members questioned how best to distribute the new scoring system to the public and encourage them to get screened. One attendee suggested that the AAA risk form could be sent to the estimated 40 million members of the AARP.

It would take 156 screenings with the current guidelines to get a single AAA, versus 85 with the scoring system.

Source DR. GRECO

My Take

Waiting for Randomized Trials

Dr. Greco and his colleagues correctly point out that this scoring system needs to be prospectively validated before it can be used. This is particularly important when the data set is not all comers that arrive in our day to day practice, but those who specifically have sought out screening. This creates a selection bias.

If the authors are able to validate the scoring system, the next question becomes “Does the screening make a difference in outcomes?” The reason the current U.S. Preventive Services Task Force guidelines do not recommend screening in women is because screening studies have not demonstrated an improved outcome in women screened for AAA compared to those not screened.

Before this scoring tool is used in practice, it needs to be prospectively tested in a randomized controlled trial demonstrating that it helps improve patient outcomes, and it should be compared in some fashion to the current guideline. I have plenty to do already trying to manage the 30%-plus of the population who is obese, let alone trying to ferret out conditions that affect 0.14% of the population, when I don't know that finding them with a new screening tool will change outcomes.

PAUL OGDEN, M.D., M.S.P.H., is a family physician in private practice in Denver. He practices age management medicine and consults in preventive medicine. He served on the development team for Kaiser Permanente's current AAA screening clinical practice guideline.

Major Finding: At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL cholesterol was associated with a 6.7-g increase in fetal birth weight.

Data Source: A prospective study of 143 women whose cholesterol and triglyceride levels and whose fetuses' birth weights were measured five times during pregnancy.

Disclosures: The study was funded by the Doris Duke Charitable Foundation Clinical Research Fellowship and the National Institutes of Health. The authors disclosed no conflicts of interest.

CHICAGO — Decreased maternal HDL cholesterol during pregnancy is significantly associated with increased fetal birth weight, according to initial data from the ongoing prospective, longitudinal GROW study.

This association was particularly apparent in overweight and obese women, Dr. Uma Perni and Dr. Vinod K. Misra wrote in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“We believe that having an unhealthy lipid profile may be part of what causes large infants, who then are later at risk for chronic diseases in their lifetime,” Dr. Perni said in an interview.

Prenatal events are thought to establish lifelong physiological patterns that may manifest as diseases in later life. In 1995, the British Medical Journal named this idea the “Barker Hypothesis” based on work by British physician and epidemiologist David Barker who demonstrated that people who had a low birth weight are at greater risk of developing coronary heart disease.

The Gestational Regulators of Weight (GROW) study is the first to document the relationship between variations in birth weight and maternal serum lipids measured at multiple time points during pregnancy, according to the authors.

The researchers measured serum levels of triglycerides, HDL cholesterol, LDL cholesterol and total cholesterol in 143 women at five time points during pregnancy: 6-10 weeks' gestation, 10-14 weeks, 16-20 weeks, 22-26 weeks, and 32-36 weeks. Linear regression analyses were conducted, with fetal birth weight adjusted for gestational age determined by a first-trimester dating scan.

In all, 85 women had a low/normal weight (body mass index 18-26 kg/m

A significant inverse relationship was observed between adjusted birth weight and HDL cholesterol at all five time points, reported Dr. Perni, an ob.gyn. at the University of Michigan, and Dr. Misra of the department of pediatrics and communicable diseases at C.S. Mott Children's Hospital, Ann Arbor. For example, at 32-36 weeks' gestation, a 6.7-g increase in birth weight was associated with a 1-mg/dL decrease in HDL cholesterol. The increase in birth weight associated with a 1-mg/dL decrease in HDL cholesterol was 5.7 g at 6-10 weeks' gestation, 5.4 g at 10-14 weeks, 5.0 g at 16-20 weeks, and 6.2 g at 22-26 weeks.

Birth weight was also significantly linked with triglycerides at 10-14 weeks' gestation, 22-26 weeks, and 32-36 weeks.

No significant association was observed between birth weight and total cholesterol or LDL cholesterol at any time point.

After the analyses were stratified by maternal prepregnancy BMI, the association between HDL cholesterol and birth weight was significant for low- and normal-weight women only at 32-36 weeks' gestation. At that time point, a 1-mg/dL decrease in HDL cholesterol was associated with an increased birth weight of 5.4 g.

The association, however, remained significant for overweight and obese women at all time points, the authors reported. At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL cholesterol was associated with an increased birth weight of 9.6 g.

Major Finding: At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL cholesterol was associated with a 6.7-g increase in fetal birth weight.

Data Source: A prospective study of 143 women whose cholesterol and triglyceride levels and whose fetuses' birth weights were measured five times during pregnancy.

Disclosures: The study was funded by the Doris Duke Charitable Foundation Clinical Research Fellowship and the National Institutes of Health. The authors disclosed no conflicts of interest.

CHICAGO — Decreased maternal HDL cholesterol during pregnancy is significantly associated with increased fetal birth weight, according to initial data from the ongoing prospective, longitudinal GROW study.

This association was particularly apparent in overweight and obese women, Dr. Uma Perni and Dr. Vinod K. Misra wrote in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“We believe that having an unhealthy lipid profile may be part of what causes large infants, who then are later at risk for chronic diseases in their lifetime,” Dr. Perni said in an interview.

Prenatal events are thought to establish lifelong physiological patterns that may manifest as diseases in later life. In 1995, the British Medical Journal named this idea the “Barker Hypothesis” based on work by British physician and epidemiologist David Barker who demonstrated that people who had a low birth weight are at greater risk of developing coronary heart disease.

The Gestational Regulators of Weight (GROW) study is the first to document the relationship between variations in birth weight and maternal serum lipids measured at multiple time points during pregnancy, according to the authors.

The researchers measured serum levels of triglycerides, HDL cholesterol, LDL cholesterol and total cholesterol in 143 women at five time points during pregnancy: 6-10 weeks' gestation, 10-14 weeks, 16-20 weeks, 22-26 weeks, and 32-36 weeks. Linear regression analyses were conducted, with fetal birth weight adjusted for gestational age determined by a first-trimester dating scan.

In all, 85 women had a low/normal weight (body mass index 18-26 kg/m

A significant inverse relationship was observed between adjusted birth weight and HDL cholesterol at all five time points, reported Dr. Perni, an ob.gyn. at the University of Michigan, and Dr. Misra of the department of pediatrics and communicable diseases at C.S. Mott Children's Hospital, Ann Arbor. For example, at 32-36 weeks' gestation, a 6.7-g increase in birth weight was associated with a 1-mg/dL decrease in HDL cholesterol. The increase in birth weight associated with a 1-mg/dL decrease in HDL cholesterol was 5.7 g at 6-10 weeks' gestation, 5.4 g at 10-14 weeks, 5.0 g at 16-20 weeks, and 6.2 g at 22-26 weeks.

Birth weight was also significantly linked with triglycerides at 10-14 weeks' gestation, 22-26 weeks, and 32-36 weeks.

No significant association was observed between birth weight and total cholesterol or LDL cholesterol at any time point.

After the analyses were stratified by maternal prepregnancy BMI, the association between HDL cholesterol and birth weight was significant for low- and normal-weight women only at 32-36 weeks' gestation. At that time point, a 1-mg/dL decrease in HDL cholesterol was associated with an increased birth weight of 5.4 g.

The association, however, remained significant for overweight and obese women at all time points, the authors reported. At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL cholesterol was associated with an increased birth weight of 9.6 g.

Major Finding: At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL cholesterol was associated with a 6.7-g increase in fetal birth weight.

Data Source: A prospective study of 143 women whose cholesterol and triglyceride levels and whose fetuses' birth weights were measured five times during pregnancy.

Disclosures: The study was funded by the Doris Duke Charitable Foundation Clinical Research Fellowship and the National Institutes of Health. The authors disclosed no conflicts of interest.

CHICAGO — Decreased maternal HDL cholesterol during pregnancy is significantly associated with increased fetal birth weight, according to initial data from the ongoing prospective, longitudinal GROW study.

This association was particularly apparent in overweight and obese women, Dr. Uma Perni and Dr. Vinod K. Misra wrote in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“We believe that having an unhealthy lipid profile may be part of what causes large infants, who then are later at risk for chronic diseases in their lifetime,” Dr. Perni said in an interview.

Prenatal events are thought to establish lifelong physiological patterns that may manifest as diseases in later life. In 1995, the British Medical Journal named this idea the “Barker Hypothesis” based on work by British physician and epidemiologist David Barker who demonstrated that people who had a low birth weight are at greater risk of developing coronary heart disease.

The Gestational Regulators of Weight (GROW) study is the first to document the relationship between variations in birth weight and maternal serum lipids measured at multiple time points during pregnancy, according to the authors.

The researchers measured serum levels of triglycerides, HDL cholesterol, LDL cholesterol and total cholesterol in 143 women at five time points during pregnancy: 6-10 weeks' gestation, 10-14 weeks, 16-20 weeks, 22-26 weeks, and 32-36 weeks. Linear regression analyses were conducted, with fetal birth weight adjusted for gestational age determined by a first-trimester dating scan.

In all, 85 women had a low/normal weight (body mass index 18-26 kg/m

A significant inverse relationship was observed between adjusted birth weight and HDL cholesterol at all five time points, reported Dr. Perni, an ob.gyn. at the University of Michigan, and Dr. Misra of the department of pediatrics and communicable diseases at C.S. Mott Children's Hospital, Ann Arbor. For example, at 32-36 weeks' gestation, a 6.7-g increase in birth weight was associated with a 1-mg/dL decrease in HDL cholesterol. The increase in birth weight associated with a 1-mg/dL decrease in HDL cholesterol was 5.7 g at 6-10 weeks' gestation, 5.4 g at 10-14 weeks, 5.0 g at 16-20 weeks, and 6.2 g at 22-26 weeks.

Birth weight was also significantly linked with triglycerides at 10-14 weeks' gestation, 22-26 weeks, and 32-36 weeks.

No significant association was observed between birth weight and total cholesterol or LDL cholesterol at any time point.

After the analyses were stratified by maternal prepregnancy BMI, the association between HDL cholesterol and birth weight was significant for low- and normal-weight women only at 32-36 weeks' gestation. At that time point, a 1-mg/dL decrease in HDL cholesterol was associated with an increased birth weight of 5.4 g.

The association, however, remained significant for overweight and obese women at all time points, the authors reported. At 32-36 weeks' gestation, a 1-mg/dL decrease in HDL cholesterol was associated with an increased birth weight of 9.6 g.

CHICAGO — Central arterial compliance is improved following magnesium infusion in women with preeclampsia, according to a prospective, observational study in 70 patients.

“Magnesium may improve perfusion to end organs by decreasing arterial stiffness, suggesting a benefit beyond seizure prophylaxis,” Dr. Dennie Rogers said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a normal pregnancy, arterial compliance increases by 30% in the first trimester and remains elevated until returning to normal levels 6 weeks post partum. Enhanced arterial compliance is part of the normal adaptation to increased intravascular volume during pregnancy. In preeclampsia, this adaptive mechanism is blunted, explained Dr. Rogers, an ob.gyn. at the University of Illinois at Chicago.

The investigators used applanation tonometry to capture radial pulse waveforms at four time points in 70 women with preeclampsia undergoing magnesium therapy for seizure prophylaxis. From these waveforms they derived the aortic waveform and calculated the augmentation pressure (AP) index and augmentation index corrected at 75 beats per minute (Alx@75). The indices are surrogate measures of arterial compliance. The four time points measured were before magnesium administration, 1 hour after a magnesium bolus, 4 hours after maintenance magnesium infusion, and 24 hours after magnesium infusion completion.

The AP and Alx@75 values were significantly lower at all three times points following magnesium administration, compared with pre-magnesium administration, indicating an improvement in radial stiffness, she said. The effect was most pronounced 4 hours after the infusion began, but persisted for 24 hours following magnesium completion. Notably, brachial blood pressures were not clinically or statistically different at any time line, suggesting that arterial compliance cannot be reliably inferred from traditional brachial pressure.

“Our research suggests that central arterial pressure waveforms may better characterize the pulsatile component of the vascular system,” she said. “This may lead to more effective dosing of medications and improved treatment of hypertensive disorders in pregnancy.”

During a discussion of the study, Dr. Rogers noted that use of radial artery pulse waveforms has been validated in nonpregnant populations but not in pregnancy. Session moderator Dr. Norman Gant of the University of Texas at Dallas, said that another team of investigators observed the same findings using magnesium in pregnant women, but these results were not written down.

Disclosures: None was reported.

CHICAGO — Central arterial compliance is improved following magnesium infusion in women with preeclampsia, according to a prospective, observational study in 70 patients.

“Magnesium may improve perfusion to end organs by decreasing arterial stiffness, suggesting a benefit beyond seizure prophylaxis,” Dr. Dennie Rogers said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a normal pregnancy, arterial compliance increases by 30% in the first trimester and remains elevated until returning to normal levels 6 weeks post partum. Enhanced arterial compliance is part of the normal adaptation to increased intravascular volume during pregnancy. In preeclampsia, this adaptive mechanism is blunted, explained Dr. Rogers, an ob.gyn. at the University of Illinois at Chicago.

The investigators used applanation tonometry to capture radial pulse waveforms at four time points in 70 women with preeclampsia undergoing magnesium therapy for seizure prophylaxis. From these waveforms they derived the aortic waveform and calculated the augmentation pressure (AP) index and augmentation index corrected at 75 beats per minute (Alx@75). The indices are surrogate measures of arterial compliance. The four time points measured were before magnesium administration, 1 hour after a magnesium bolus, 4 hours after maintenance magnesium infusion, and 24 hours after magnesium infusion completion.

The AP and Alx@75 values were significantly lower at all three times points following magnesium administration, compared with pre-magnesium administration, indicating an improvement in radial stiffness, she said. The effect was most pronounced 4 hours after the infusion began, but persisted for 24 hours following magnesium completion. Notably, brachial blood pressures were not clinically or statistically different at any time line, suggesting that arterial compliance cannot be reliably inferred from traditional brachial pressure.

“Our research suggests that central arterial pressure waveforms may better characterize the pulsatile component of the vascular system,” she said. “This may lead to more effective dosing of medications and improved treatment of hypertensive disorders in pregnancy.”

During a discussion of the study, Dr. Rogers noted that use of radial artery pulse waveforms has been validated in nonpregnant populations but not in pregnancy. Session moderator Dr. Norman Gant of the University of Texas at Dallas, said that another team of investigators observed the same findings using magnesium in pregnant women, but these results were not written down.

Disclosures: None was reported.

CHICAGO — Central arterial compliance is improved following magnesium infusion in women with preeclampsia, according to a prospective, observational study in 70 patients.

“Magnesium may improve perfusion to end organs by decreasing arterial stiffness, suggesting a benefit beyond seizure prophylaxis,” Dr. Dennie Rogers said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a normal pregnancy, arterial compliance increases by 30% in the first trimester and remains elevated until returning to normal levels 6 weeks post partum. Enhanced arterial compliance is part of the normal adaptation to increased intravascular volume during pregnancy. In preeclampsia, this adaptive mechanism is blunted, explained Dr. Rogers, an ob.gyn. at the University of Illinois at Chicago.

The investigators used applanation tonometry to capture radial pulse waveforms at four time points in 70 women with preeclampsia undergoing magnesium therapy for seizure prophylaxis. From these waveforms they derived the aortic waveform and calculated the augmentation pressure (AP) index and augmentation index corrected at 75 beats per minute (Alx@75). The indices are surrogate measures of arterial compliance. The four time points measured were before magnesium administration, 1 hour after a magnesium bolus, 4 hours after maintenance magnesium infusion, and 24 hours after magnesium infusion completion.

The AP and Alx@75 values were significantly lower at all three times points following magnesium administration, compared with pre-magnesium administration, indicating an improvement in radial stiffness, she said. The effect was most pronounced 4 hours after the infusion began, but persisted for 24 hours following magnesium completion. Notably, brachial blood pressures were not clinically or statistically different at any time line, suggesting that arterial compliance cannot be reliably inferred from traditional brachial pressure.

“Our research suggests that central arterial pressure waveforms may better characterize the pulsatile component of the vascular system,” she said. “This may lead to more effective dosing of medications and improved treatment of hypertensive disorders in pregnancy.”

During a discussion of the study, Dr. Rogers noted that use of radial artery pulse waveforms has been validated in nonpregnant populations but not in pregnancy. Session moderator Dr. Norman Gant of the University of Texas at Dallas, said that another team of investigators observed the same findings using magnesium in pregnant women, but these results were not written down.

Disclosures: None was reported.

Major Finding: About 30 g of dark chocolate per day during pregnancy was associated with systolic and diastolic blood pressure levels that were lower by 8.32 mm Hg and 3.76 mm Hg, respectively, than those of women in a control group.

Data Source: Longitudinal study in 80 women.

Disclosures: None was reported.

CHICAGO — A daily dosage of 30 g of dark chocolate during pregnancy was associated with lower blood pressures and a reduced risk of anemia, Italian researchers reported.

Oral glucose tolerance testing revealed no alterations in the 40 women fed dark chocolate, while gestational diabetes was detected in 2 of the 40 controls, Dr. Gian Carlo Di Renzo, chair of obstetrics and gynecology at the University of Perugia (Italy), and his colleagues reported in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” they wrote.

Women were fed dark chocolate beginning at their first prenatal visit at 9-12 weeks. None of the women given dark chocolate developed anemia in pregnancy, but 65% of controls needed iron supplementation starting at 24 weeks' gestation.

The 30 g of chocolate, 70% cocoa content, contained 10 mg of iron, 6 mcg of folic acid, 0.3 mg of vitamin E, 194 mg of theobromine and 29.4 mg of flavonols.

In a prospective cohort of 2,291 pregnant women, Yale University investigators reported that chocolate consumption was associated with a lower risk of preeclampsia, a pregnancy complication that shares many characteristics of cardiovascular disease including endothelial dysfunction (Epidemiology. 2008;19:459-64).

In the current analysis, blood pressure values were lower at all time points during gestation among women eating chocolate. At the final checkup before they gave birth, controls had systolic and diastolic blood pressure levels that were higher by 8.32 mm Hg and 3.76 mm Hg.

The 160-calorie dose of dark chocolate did not affect weight gain. Cesarean section rates were also equivalent at 32% in both groups.

“Dark chocolate is a well-accepted and valuable supplemental food in pregnancy,” they wrote.

Major Finding: About 30 g of dark chocolate per day during pregnancy was associated with systolic and diastolic blood pressure levels that were lower by 8.32 mm Hg and 3.76 mm Hg, respectively, than those of women in a control group.

Data Source: Longitudinal study in 80 women.

Disclosures: None was reported.

CHICAGO — A daily dosage of 30 g of dark chocolate during pregnancy was associated with lower blood pressures and a reduced risk of anemia, Italian researchers reported.

Oral glucose tolerance testing revealed no alterations in the 40 women fed dark chocolate, while gestational diabetes was detected in 2 of the 40 controls, Dr. Gian Carlo Di Renzo, chair of obstetrics and gynecology at the University of Perugia (Italy), and his colleagues reported in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” they wrote.

Women were fed dark chocolate beginning at their first prenatal visit at 9-12 weeks. None of the women given dark chocolate developed anemia in pregnancy, but 65% of controls needed iron supplementation starting at 24 weeks' gestation.

The 30 g of chocolate, 70% cocoa content, contained 10 mg of iron, 6 mcg of folic acid, 0.3 mg of vitamin E, 194 mg of theobromine and 29.4 mg of flavonols.

In a prospective cohort of 2,291 pregnant women, Yale University investigators reported that chocolate consumption was associated with a lower risk of preeclampsia, a pregnancy complication that shares many characteristics of cardiovascular disease including endothelial dysfunction (Epidemiology. 2008;19:459-64).

In the current analysis, blood pressure values were lower at all time points during gestation among women eating chocolate. At the final checkup before they gave birth, controls had systolic and diastolic blood pressure levels that were higher by 8.32 mm Hg and 3.76 mm Hg.

The 160-calorie dose of dark chocolate did not affect weight gain. Cesarean section rates were also equivalent at 32% in both groups.

“Dark chocolate is a well-accepted and valuable supplemental food in pregnancy,” they wrote.

Major Finding: About 30 g of dark chocolate per day during pregnancy was associated with systolic and diastolic blood pressure levels that were lower by 8.32 mm Hg and 3.76 mm Hg, respectively, than those of women in a control group.

Data Source: Longitudinal study in 80 women.

Disclosures: None was reported.

CHICAGO — A daily dosage of 30 g of dark chocolate during pregnancy was associated with lower blood pressures and a reduced risk of anemia, Italian researchers reported.

Oral glucose tolerance testing revealed no alterations in the 40 women fed dark chocolate, while gestational diabetes was detected in 2 of the 40 controls, Dr. Gian Carlo Di Renzo, chair of obstetrics and gynecology at the University of Perugia (Italy), and his colleagues reported in a poster at the annual meeting of the Society for Maternal-Fetal Medicine.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” they wrote.

Women were fed dark chocolate beginning at their first prenatal visit at 9-12 weeks. None of the women given dark chocolate developed anemia in pregnancy, but 65% of controls needed iron supplementation starting at 24 weeks' gestation.

The 30 g of chocolate, 70% cocoa content, contained 10 mg of iron, 6 mcg of folic acid, 0.3 mg of vitamin E, 194 mg of theobromine and 29.4 mg of flavonols.

In a prospective cohort of 2,291 pregnant women, Yale University investigators reported that chocolate consumption was associated with a lower risk of preeclampsia, a pregnancy complication that shares many characteristics of cardiovascular disease including endothelial dysfunction (Epidemiology. 2008;19:459-64).

In the current analysis, blood pressure values were lower at all time points during gestation among women eating chocolate. At the final checkup before they gave birth, controls had systolic and diastolic blood pressure levels that were higher by 8.32 mm Hg and 3.76 mm Hg.

The 160-calorie dose of dark chocolate did not affect weight gain. Cesarean section rates were also equivalent at 32% in both groups.

“Dark chocolate is a well-accepted and valuable supplemental food in pregnancy,” they wrote.