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Poster Session V Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging www.AJOG.org

802 The utility of antepartum depression screeningmong inner-city pregnant women

Gennadiy Ivanov1, Fatima Hina1, Baraallaf2, Donna Slawek1, Lani Burkman1

1University at Buffalo, Buffalo, NY, 2Stony Brook-Winthrop University Hospitals, Long Island, NYOBJECTIVE: To estimate both prevalence and risk factors for antepar-um depression; document patient intervention; and assess the use-ulness of a patient-screening questionnaire.

STUDY DESIGN: Prenatal questionnaires were conducted during thehird trimester (�28 weeks) at an inner-city prenatal clinic in Westernew York.The screening questionnaire was based on the Edinburghostnatal Depression Scale (EPDS).Total questionnaire score (QS),anging from 0 to 30, with � 10 used as the cut-off to define depres-ion, instead of the standard 12. The data analysis focused on: totaluestionnaire score (QS); patient age; response to a question on sui-idal ideation (SI); intervention from the medical staff; and residencen a low socioeconomic area.

RESULTS: A total of 521 patients completed the questionnaire, 28.8%n�150) were considered to have depression (QS cut-off � 10), and

4.2% (n�22) of them indicated suicidal ideation. Within the antepar-tum depression group, the median QS was 13 (range of 10-30) and theaverage age was 23 � 4.7 years. Among all women who were de-pressed, the peak age group was 20 to 24 years, i.e. 42 % (n�63) of alldepressed patients. The highest rates of suicidal ideation 49% (n�12)also occurred for women aged 20 to 24 years of the SI group. Signifi-cantly higher rates of depression occurred in areas of low socioeco-nomic status (P�0.001). By using a lower QS cut-off value (� 10),compared to 12 as the cut-off, 54 additional depressed patients (� 36% with depression) were identified including 7 cases with suicidalideation. Finally, as the depression score (QS) increased above 9, thepercentage of women receiving staff assistance for depression alsoincreased.CONCLUSIONS: These data indicate that screening with a question-

aire, such as the EPDS, could be useful for antepartum depressionetection especially when using a cut off �10. Age andsocioeconomictatus are risk factors for development of depression. Adequate med-cal and social resources in our community should be available todentify and treat depression in pregnancy.

803 Excessive early gestational weight gain and risksf gestational diabetes and large for gestationalge infants in nulliparous women

Carlos Carreno1

1For the Eunice Kennedy Shriver National Institute ofhild Health and Human Development Maternal-etal Medicine Units Network, Bethesda, MD

OBJECTIVE: Increased total gestational weight gain (GWG) is associ-ted with glucose intolerance and excessive fetal growth. Our purposeas to determine whether there is an association between excessive

arly GWG and the development of gestational diabetes (GDM) andxcessive fetal growth.

STUDY DESIGN: This is a secondary analysis of a RCT of antioxidantitamins in nulliparous low risk women. Maternal weight gain fromelf-reported pre-pregnancy to 15-18 weeks’ gestation was measurednd expected GWG was determined using the IOM 2009 guidelinesor each pre-pregnancy BMI category (underweight [UW], normaleight [NW], overweight [OW], and obese [OB]). Excessive earlyWG was defined using the upper range of the IOM guidelines: � 4.4ounds in the first trimester plus second trimester weight gain pereek of 1.3 (UW), 1.0 (NW), 0.7 (OW), and 0.6 (OB). Rates of GDM,irth weight (BW) �4000g and LGA (BW �90th %ile) were calcu-

ated and compared between women with excessive early GWG andon-excessive early GWG (within or below [WB] IOM guidelines).Rs were adjusted for maternal age, race, smoking and treatment

roup (vitamins versus placebo). e

S314 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

RESULTS: A total of 7,985 women were studied. Excessive early GWGccurred in 47.6% of women (UW: 45.2%, NW: 45.8%, OW: 54.0%,B: 45.1%). Ninety-two percent of women with excessive early GWGad total GWG �IOM guidelines. In contrast, only 55% of womenith WB GWG had total GWG �IOM guidelines (p�0.0001). Ratesf GDM, LGA, and BW � 4000 grams were higher in NW with exces-ive early GWG (Table).

CONCLUSIONS: In low risk nulliparous women, excessive early GWG isssociated with the development of GDM and excessive fetal growth.

OutcomeBMICategory

ExcessiveEarly GWGN�3,797(%)

WB EarlyGWGN�4,188(%)

Adj OR(95% CI)

DM Overall 4.0 2.5 1.4 (1.1-1.8)..........................................................................................................................................................................................

Underweight 1.1 0.5 -..........................................................................................................................................................................................

NormalWeight

2.6 1.4 1.7 (1.1-2.7)

..........................................................................................................................................................................................

Overweight 5.3 3.0 1.6 (1.0-2.6)..........................................................................................................................................................................................

Obese 7.6 5.9 1.2 (0.8-1.9)..........................................................................................................................................................................................

BW � 4000grams

Overall 8.4 5.6 1.5 (1.3-1.8)

..........................................................................................................................................................................................

Underweight 2.3 0.5 -..........................................................................................................................................................................................

NormalWeight

7.6 4.7 1.7 (1.3-2.1)

..........................................................................................................................................................................................

Overweight 10.5 8.0 1.3 (0.9-1.8)..........................................................................................................................................................................................

Obese 9.0 7.4 1.3 (0.9-1.9)..........................................................................................................................................................................................

LGA Overall 12.0 9.1 1.4 (1.2-1.6)..........................................................................................................................................................................................

Underweight 9.4 5.8 1.7 (0.8-3.9)..........................................................................................................................................................................................

NormalWeight

12.3 9.4 1.4 (1.2-1.7)

..........................................................................................................................................................................................

Overweight 14.4 10.8 1.4 (1.0-1.8)..........................................................................................................................................................................................

Obese 8.3 7.5 1.1 (0.8-1.7)..........................................................................................................................................................................................

804 Risk factors, rate and mortality associatedith cardiomyopathy in pregnancy

Chad Grotegut1, Margaret Jamison2, Andra James1

1Duke University, Durham, NC, 2CDC/National Centerfor Health Statistics, Research Triangle Park, NCOBJECTIVE: The objective of this study was to determine risk factors fornd mortality associated with cardiomyopathy in pregnancy.

STUDY DESIGN: The Nationwide Inpatient Sample for the years 2000-2007 was queried for all pregnancy-related discharges. The ICD-9codes for cardiomyopathy were used to identify cases.RESULTS: From the years 2000-2007, there were 36,930 records with a

iagnosis of cardiomyopathy for a rate of 0.98 per 1000 pregnancy-elated discharges. There was an increase in the rate of pregnancy-ssociated cardiomyopathy over the eight-year period (Figure, 0.68nd 1.35 per 1000 deliveries in 2000 and 2007, respectively). Multi-ariable logistic regression demonstrated that pre-existing heart dis-ase and chronic hypertension best predicted cardiomyopathy inregnancy diagnosed both at time of delivery (OR 71.3, 95% CI 62.2,1.8 and OR 2.9, 95% CI 2.6, 3.3, respectively) or during a postpartumdmission (OR 4.5, 95% CI 3.9, 5.2 and OR 2.8, 95% CI 2.5, 3.2,espectively). A diagnosis of cardiomyopathy was present in 377 or% of the 4647 maternal deaths during the 8-year period.

CONCLUSIONS: Pre-existing maternal heart disease and chronic hyper-ension best predicted risk for cardiomyopathy in pregnancy. The ratef pregnancy-associated cardiomyopathy has increased over the

ight-year period from 2000 to 2007.

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