356 BIRTHWEIGHT, GESTATIONAL AGE, AND PERINATAL MORTALITYAND MORBIDITY IN TRIPLETS, QUADRUPLETS, AND QUINTUPLETSREBECCA GIBSON1, SHI WU WEN2, HONGZHUAN TAN2, KAREN FUNGKEE FUNG3, MARK WALKER3, 1University of Ottawa, Ottawa, Ontario,Canada 2University of Ottawa, Obstetrics & Gynecology, Ottawa, Ontario,Canada 3University of Ottawa, Maternal-Fetal Medicine, Ottawa, Ontario,Canada

OBJECTIVE:High-ordermultiple gestations have an elevated risk of infantsbeing born small, early in gestation, and with complications.

The aim of this study was to describe the increase in low birthweight, earlygestational age, and increased perinatal mortality & morbidity with increasingfetal number.

STUDY DESIGN: We did a population-based cohort study of 1995-1997multiple births in the U.S. Analysis was restricted to triplets, quadruplets, &quintuplets born between 24 and 38 weeks’ gestation. Rates of fetal death andcongenital anomalies were calculated among total births. Means of gestationalage and birthweight, birthweight by gestational age, rates of neonatal death,seizure, mechanical ventilation were calculated among live births.

RESULTS: Gestational age at birth was predicted by fetal number, withhigher numbers of fetuses having a decreased length of gestation. Meangestational ages of triplets, quads, & quints were 32.1, 30.4, & 28.8 weeks,respectively. Birthweights per gestational age also decreased with increasing fetalnumber (Figure 1). Perinatal mortality rates varied by plurality, with triplet,quad, & quint rates calculated to be 9.6%, 12.1%, & 29.3%. Rates of fetal death,neonatal death, congenital anomaly, seizure, mechanical ventilation were 2.9%,6.9%, 2.7%, 0.1%, & 15.8%, respectively, for triplets; 4.4%, 8.0%, 3.0%, 0.1%, &21.7% for quads; and 8.8%, 22.5%, 1.0%, 0%, & 19.8% for quints.

CONCLUSION: Birthweight, length of gestation, and risk of mortality &morbidity in multiples are incrementally related to fetal number. Infants ofmultiple gestation should be evaluated using plurality-specific standards ratherthan singleton references.

357 MATERNAL DEPRESSIVE SYMPTOMATOLOGY AND PRETERM BIRTH( < 35 WEEKS’ GESTATION) AMONG LOW-INCOME WOMEN KELLYMCCOLLUM1, ESTHER CHUNG2, JENNIFER CULHANE1, 1Thomas Jeffer-son University, Department of Obstetrics and Gynecology, Philadelphia, PA2Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA

OBJECTIVE: To assess the association between maternal depressivesymptomatology and preterm birth.

STUDY DESIGN: Women were enrolled at their first prenatal visit (meanGA ± SE: 13.7 ± 0.1 weeks) at public clinics in Philadelphia. Demographic,behavioral, and psychosocial data were obtained by interview. Participant datawere linked to birth records to obtain gestational age at birth and other controlvariables. Maternal depressive symptomatology was measured by the Center forEpidemiologic Studies for Depression Scale (CES-D). Participants wereclassified into one of three groups based on their CES-D score: not depressed(ND; < 16), possibly depressed (PD;$16 and< 22), and probably depressed(PRD;$22). Pretermbirth (PTB) was defined as a live birth of less than 35weeks’gestation. Participants were excluded if they had preeclampsia, chronic orpregnancy-related hypertension, diabetes, or renal disease. Multiple logisticregression was used to obtain the relative risk of delivering preterm among thedepression groups and to control for confounders.

RESULTS: A total of 1988 women were included in this analysis. Themajority of participants were single (74%),U.S.-born (77%), low-incomewomen(median yearly income: $5798) who did not have an education beyond highschool (82%). About half were primiparous. Twenty-three percent wereclassified as PRD, 16% as PD, and 61% as ND. The incidence of PTB was5.5%. After controlling for sociodemographic, biomedical, and behavioralcharacteristics, there was no statistically significant association betweenmaternal depression and PTB: (1) PD vs ND: RR (95%CI): 0.93 (0.62-1.39),(2) PRD vs ND: RR (95%CI): 1.08 (0.77, 1.51).

CONCLUSION: Maternal depressive symptomatology is not associated withan increased or decreased risk of preterm birth ( <35 weeks’ gestation) in low-income, urban women.

358

359

Figure 1. Birthweight by gestational age for live births (grams vs weeks)

Volume 189, Number 6Am J Obstet Gynecol

SMFM Abstracts S159

CAN WE IDENTIFY WOMEN AT INCREASED RISK OF NOT SEEKINGHELP FOLLOWING DOMESTIC ABUSE? RICHARD BENOIT1, 1Women &Infants’ Hospital, Providence, RI

OBJECTIVE: To identify correlates of women experiencing domestic abusewho do not seek any form of help. This can lead to serious consequences,particularly in pregnancy, where correlates of battering are similar to thoseoutside of pregnancy.

STUDY DESIGN: The public access data set of the Chicago Women’sHealth Risk Survey was obtained. Women receiving care at four clinical sites inurban Chicago were surveyed. 497 reporting abuse (30% pregnant) were askedabout help-seeking (formal and informal) within the previous year. Univariateand bivariate analyses were performed. A dependent variable of interest,helpseek, was created to describe the types of help sought. Multivariate logisticregression and an ROC modeled the outcome helpseek, predicting probabilityof an abused women not seeking any help.

RESULTS: 70% of the women were African American. 18% had not soughtany help following abuse (helpseek = 0). Bivariate analyses revealed variablescorrelated with an increased odds of not seeking help included having children(OR 2.3, 95% CI 1.13-4.6), power score < 25th percentile (OR 2.86, 95% CI 1.6-5), harassment score < 25th percentile (OR 2.4, 95%CI 1.4-4.2), social supportscale < 25th percentile (OR 2, 95%CI 1.19-3.36), partner having abused drugs(OR 2, 95%CI 1.2-3.4), and reported race black (OR 1.96, 95% CI 1.2-3.14).Multivariate logistic regression for the outcome helpseek = 0 revealed that theprobability of being in the group of abused woman who did not seek help wasincreased with unemployment, a partner abusing drugs, low power and controlscores, and low social support score. The ROC revealed that a probability of 0.5as a positive screen had a sensitivity of 16%, specificity of 99%, and LR of 10.7 topredict not seeking help following abuse.

CONCLUSION: Identifying correlates of women experiencing domesticabuse who do not seek help may improve screening and offers the potential fordeveloping interventions to empower women to deal with their abusereffectively, and to seek timely assistance.

HOW USEFUL IS FIRST-TRIMESTER INCREASED NUCHAL TRANSLU-CENCY AS A SCREENING TOOL FOR THE DETECTION OF CONGEN-ITAL HEART DISEASE? RICHARD BENOIT1, 1Women & Infants’ Hospital,Providence, RI

OBJECTIVE: To describe the diagnostic accuracy and utility of increasednuchal translucency (NT) thickness in the detection of congenital heart disease(CHD) with a meta-analysis.

STUDY DESIGN: Selection criteria included population-based cohort stud-ies, retrospective & prospective, describing the use of fetal nuchal translucencythickness between 10 and 14 weeks’ gestation for first-trimester screening.Antenatal and postnatal outcomes must have been assessed, particularly karyo-type and prevalence of congenital heart anomalies. Studies included reportedthe outcome of a chromsomal normal cohort with respect to nuchal trans-lucency thickness between 10 and 14 weeks’ gestation, allowing determinationof relative risk, sensitivity, specificity, likelihood ratio, and risk difference for anabnormal test and congenital heart malformation (with 95% CI). Theprevalence of CHD in the population screened was described as high or low.

RESULTS: Five cohort studies met inclusion criteria (4 prospective, 1retrospective). All five assessed a low-risk population, confirmed by prevalencerange of 1.7 to 3.3 per 1000. Among three of the studies reporting aNT$2.5mmas a cutoff for abnormal screen, sensitivity for the detection of congenital heartanomaly among chromosomally normal live births ranged from 15%-27%;specificity, 97%-99%, and likelihood ratio from 4.4 to 18.5. Among the tworeporting NT $95th percentile with respect to crown-rump length norms,sensitivity ranged from 36%-56%; specificity, 94%-97%; and likelihood ratio,positive 9 to 10.8. For the three studies reporting NT $99th percentile or $3.5mm, sensitivity ranged from 12%-40%; specificity, 99%; and likelihood ratio,positive 14.8 to 39. The risk difference for a NT $99% was 4%-6%.

CONCLUSION: Nuchal translucency (NT) measurement between 10 and14 weeks’ gestation is a useful screening tool in the low-risk population for thedetection of congenital heart disease, warranting referral for fetal echocardi-ography.