208: Echocardiographic changes in maternal cardiac structure and function from the first trimester to 6 months postpartum

structure and function from the first trimester to 6 months postpartum Janet Burlingame, Hyeong Jun Ahn, Todd Seto University of Hawaii, John A. Burns School of Medicine, Obstetrics, Gynecology and Womens Health, Honolulu, HI, Queens Medical Center, Center for Outcomes Research and Evaluation, Honolulu, HI, University of Hawaii, John A. Burns School of Medicine, Biostatistics Core, Honolulu, HI OBJECTIVE: To document temporal changes in diastolic function, systolic function and cardiac structure due to pregnancy. STUDY DESIGN: We performed a prospective observational study of pregnant women who were recruited in the first or second trimesters of pregnancy, and echocardiograms were done at 6 to 7 time points until 6 to 12 months postpartum. Women with hypertensive or cardiac disease were excluded from analysis. Linear mixed models were used to evaluate the changes of ECHO measures over time accounting for missing data. Tukey-Kramer method was also used for multiple comparisons as a post-hoc analysis. P values 0.05 were regarded as statistically significant. RESULTS: The Figure outlines the changes in diastolic function and the changes in structure and systolic function throughout pregnancy and the postpartum periods. Comparisons between pregnancy and nonpregnancy were also made using visit 7 (6-12 months postpartum as the non-pregnant measurement). Diastolic function changes included significant decreases in E/A and isovolumic relaxation time and an increase in transmitral E/peak medial velocity (E/E’) with a return to baseline postpartum. There was a significant increase in left atrial volume. There were trends toward increases in left ventricular volume and mitral valve deceleration time. CONCLUSION: As one of the largest prospective studies and one of the few that follows participants out to 6 months postpartum, this study confirms previous data and presents new data highlighting changes in cardiovascular physiology during pregnancy and the puerperium. Diastolic changes reflected a general decrease in function with return to baseline postpartum. Cardiac output peaks in the mid trimester in our series versus third trimester as found in previous studies. These changes are likely related to the concomitant increase in left atrial size as reflective of preload increase. The research described was supported in part by the NIH grants NCRR U54MD007584 and NIMHD G12MD007601. 209 Vitamin D deficiency: can non-pregnant treatment norms be used in pregnancy? Janyne Althaus, Sarahn Wheeler, Haitham Baghlaf, Harold Fox, Irina Burd Johns Hopkins University School of Medicine, Gynecology and Obstetrics, Baltimore, MD OBJECTIVE: To date, no treatment guidelines exist for vitamin D deficiency in pregnancy. A common treatment for non-pregnant adults is 50,000 international units (IU) weekly, but many OBs are reluctant to treat vitamin D deficiency for fear of toxicity. There are varied protocols among practices and still no consensus. The purpose of this study was to determine if treatment of low vitamin D in pregnancy with 50,000 IU weekly leads to adverse perinatal outcomes. STUDY DESIGN: This was a retrospective cohort study (2009-2011) comparing vitamin D-deficient patients ( 32ng/mL) treated with 50,000 IU weekly for 12 weeks (“treated”) during pregnancy with patients given prenatal vitamins (PNV) only (“untreated”). Inclusion criteria was D 32 ng/mL at first prenatal visit. Exclusion criteria were treatment for vitamin D deficiency within the past year or any regimens other than PNV or 50,000 IU weekly. Study data were derived from electronic and paper charts. Outcomes examined included rates of preterm delivery, pre-eclampsia, and cesarean section. Neonatal outcomes studied were rates of NICU admission, Apgar 7 at 5 minutes and umbilical cord pH. Power analysis was performed, and the two groups were compared using standard statistics. RESULTS: 231 patients met inclusion criteria: 117 in the untreated group and 114 in the treated group. Maternal demographics did not differ between the two groups in regards to age, parity, or diabetes (p 0.05 for all). For obstetrical outcomes, cesarean section, pre-eclampsia, and preterm delivery rates did not differ between the two groups (p 0.05 for all). For neonatal outcomes, there were no differences in NICU admissions, Apgar scores, or neonatal cord pHs between the two groups (p 0.05 for all). CONCLUSION: This is the first study to demonstrate that treatment of vitamin D deficiency with non-pregnancy treatment norms during pregnancy does not lead to increased rates of adverse perinatal outcomes. Studies with a larger n are needed.