What's the latest research from SMFM's annual meeting?

With more than 2200 attendees, last week’s annual meeting of the Society for Maternal-Fetal Medicine (SMFM) in San Diego was the largest gathering ever for the organization. In plenary, oral, and poster sessions, investigators presented groundbreaking new ideas in and research aimed at reducing high-risk pregnancy and complications.

One of the highlights for many attendees was The Pregnancy Foundation and SMFM dinner honoring Dr. John T. Queenan. Held to benefit the Queenan Fellowships for Global Health, the event drew a capacity crowd of 500 and featured tributes to Contemporary OB/GYN’s founder by current Editor-in-Chief Charles J. Lockwood, MD, MHCM, John T. Queenan Jr., MD, Catherine Y. Spong, MD, and Lawrence D. Platt, MD.  According to Foundation Chair Mary D’Alton, MD, and SMFM President Vincenzo Berghella, at least $452,000 has been raised to date of the $500,000 targeted to fund a mentored research fellowship at the World Health Organization, a visiting teaching fellowship at African maternal-fetal medicine programs, investigator-initiated research projects worldwide, and fellowships for faculty from resource-limited settings.

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Said Dr. Lockwood, “The evening was a fitting tribute to a man who has made seminal contributions to maternal and fetal wellbeing including key contributions to the development of Rh immunoglobulin, which has saved thousands of babies’ lives.  John has also trained many generations of residents and fellows and educated generations of practitioners through his many peer-reviewed publications, numerous textbooks and, of course, his 28 years as the founding Editor-in-Chief of Contemporary Ob/Gyn.  But this evening highlighted another aspect of his remarkable career – his tireless advocacy and field work enhancing women’s health and reducing maternal and perinatal mortality and morbidity around the world.  Thus, it was no surprise that it was a sell-out crowd and a record-breaking fundraising event both for the man and the cause.”

Next: What's the link between fetal genetic variants and some preterm births? 

Fetal genetic variants may be linked to some preterm births

An analysis of the number of gene copies in mothers and infants shows that neonatal-but not maternal-copy number variants (CNVs) may be linked with preterm birth. The findings, by researchers from the University of Alabama, were presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting in San Diego.

 “These findings may help explain what triggers early labor in some women even when they’ve done everything right during pregnancy and there’s no obvious cause for an early birth,” said March of Dimes Chief Medical Officer Edward R. B. McCabe, MD, MPH, in a SMFM press release. “The hope is that this finding may one day lead to a screening test to help identify which babies are at higher risk of an early birth.”

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In the case-control study, Biggio and colleagues examined  the association between maternal or neonatal CNVs and spontaneous preterm birth (SPTB) at <34 weeks’ gestations. Their analysis included 901 maternal cases (singleton SPTB <34 weeks) and 900 maternal controls (spontaneous labor 39 to 40 weeks) and 787 neonatal cases and 785 neonatal controls. Maternal and neonatal DNA was obtained from either blood or saliva and submitted to SNP analysis, with copy number >2 defined as duplication and <2 defined as deletion. CNV distribution, type and size were compared in a global burden analysis.

The researchers found no correlation between size or numbers of CNVs in mothers and SPTB. In neonates, however, the proportion of CNV deletions was higher in those born preterm and gene-based analysis showed that duplication of three consecutive genes on 11q11-12 and one on 11p15 involving RASSF7 were associated with SPTB.

Presenting at SMFM, principal author Joseph Biggio, MD, noted that the study is the first to examine CNVs in association with SPTB and its strengths included a stringent definition of SPTB and statistical techniques that maximize the power of the data. The effects of the involved genes, Dr. Biggio said, require validation in other cohorts of SPTB and in-depth investigation is needed of he identified CNVs and gene regions.

Biggio JR, Xiao F, Baldwin D, Bukowski R, Parry S, Esplin MS, et al.  Abstract 9: Neonatal, not maternal, copy variants are associated with spontaneous preterm birth. Am J Obstet Gynecol. 2015;212(1) Suppl: S8.

Next: Can fetal fibronectin predict spontaneous perterm birth in cases of cervical shortening?

Can quantitative fFN help predict risk of SPTB in women with cervical shortening?

Secondary analysis of an observational study by researchers from London suggest that measurement of quantitative vaginal fetal fibronectin (qfFN) in women with short cervices may help clinically stratify risk of spontaneous preterm birth (SPTB). Presenting at the Society for Maternal-Fetal Medicine annual meeting in San Diego, the authors cautioned that the results require further study but qfFN may have potential in determining need and timing of intervention in these patients.

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The EQUIPP study was performed at five locations in London in 1,132 asymptomatic patients at high risk of SPTB with singleton gestations at 22 0/7 to 27 6/7 weeks.  Incremental categories of qfFN concentrations (0-9, 10-199, and ≥200 ng/mL and cervical length cutoffs (<15 mm, <25 mm, and ≥25 mm) alone and in combination were analyzed for prediction of subsequent SPTB. Clinicians were blinded to qfFN results but qualitative fFN results were made available.

In patients with short cervices, significant modification in risk of SPTB was seen at all gestational age cut-offs, depending on fFN concentration. The SPTB rate <35 weeks was 30% in patients with cervical length <25 mm but decreased to 9.5% if qfFN was <10 and increased to 57% if qfFN was >200. The SPTB rate was 33.8% in patients with cervical length <15 but decreased to 6.3% if the qfFN was <10 and increased to 60.7% with qfFN ≥200. Among women with cervical length ≥25 mm, risk of SPTB <35 weeks was relatively low regardless of fFN level.

Hezelgrave N, Kurtzman J, Abbbott D, Seed P, Norman J, David A, et al. Abstract 10: Quantitative fetal fibronectin assessment at 22 0/7-27 6/7 weeks’ GA significantly modifies the risk of preterm birth in asymptomatic high risk patients with sonographic cervical shortening. Am J Obstet Gynecol. 2015;212(1) Suppl: S8.

Next: Can probiotics improve the metabolic profile of women with GDM?

Probiotics may help improve metabolic profile of women with gestational diabetes

Results of a randomized controlled trial presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting in San Diego suggest that probiotics may help attenuate the normal pregnancy-induced rise in total and low-density protein (LDL) cholesterol. The findings, by researchers from Dublin, hint at a potential role for the microorganisms in improving the metabolic profile of women with gestational diabetes mellitus (GDM), who are at risk of future cardiovascular disease.

The double-blind, placebo-controlled trial enrolled 115 women with a new diagnosis of GDM following a 3-hour 100 g glucose tolerance test. Randomization was to a daily probiotic (Lactobacillus sailvarius UCC118) or placebo from GDM diagnosis until delivery. Fasting blood samples collected at baseline and 4 to 6 weeks after the study start were analyzed for glucose, insulin, c-peptide, HOMA, and lipids. The primary outcome was change in fasting glucose among women who had not initiated insulin therapy.

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Baseline characteristics and insulin requirements were similar in the treatment and control groups. Among 100 women who did not receive insulin, a similar significant decrease in fasting glucose was seen irrespective of whether they received placebo or probiotics. The rise in total and LDL cholesterol, however, was significantly attenuated in those who took probiotics (6.20 pre- and 6.62 mmol/L post-therapy vs 6.29 pre- and 6.74 mmol/L post-therapy; 3.44 pre- and 3.62 mmol/L post-therapy vs 3.51 pre- and 3.75 mmol/L post-therapy; both P<0.001). No differences were seen for the other metabolic indices.

Lindsay K, Brennan L, Kennelly M, Maguire O, Smith T, Curran S, et al. Abstract 32 Impact of probiotics in women with gestational diabetes mellitus on metabolic health: A randomized control trial. Am J Obstet Gynecol. 2015;212(1) Suppl: S22.