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Society for Maternal-Fetal Medicine, Jan. 26-31, 2009

Society for Maternal-Fetal Medicine 29th Annual Meeting

The Society for Maternal-Fetal Medicine's 29th Annual Meeting took place Jan. 26 to 31 in San Diego and attracted about 1,800 attendees from around the world. The meeting presented more than 800 studies addressing advances in the prevention and treatment of common complications such as preterm birth, preeclampsia and gestational diabetes.

"This was considered one of the best, if not the best, Society for Maternal-Fetal Medicine conference because there were so many good presentations," said meeting chair Alessandro Ghidini, M.D., of the Georgetown University Medical Center in Washington, D.C. "The first day featured most of the key results of randomized clinical trials with a large number of patients and huge statistical power."

Highlights included a multicenter randomized trial of cerclage in high-risk women with shortened mid-trimester cervical length. "This is important because there have been very few randomized clinical trials in the literature," Ghidini said. "This trial showed that women with a cervical length of less than 15 millimeters (mm) may benefit from a significant prolongation of pregnancy by having a cerclage placed."

During the study, John Owen, M.D., of the University of Alabama in Birmingham and colleagues randomly assigned 302 women with a history of previous spontaneous preterm birth at less than 34 weeks and a cervical length of less than 25 mm at 16 to 22 weeks' gestation to either cerclage or no-cerclage. Overall, they found that the rate of preterm birth before 35 weeks' gestation was significantly lower in the cerclage group (32 percent versus 42 percent). But they also found that cerclage was associated with a greater benefit in women with a cervical length of less than 15 mm (odds ratio for preterm birth, 0.23) than in women with a length of 15 to 24 mm (odds ratio, 0.84).

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Another highlight included a large-scale trial to evaluate the effectiveness of antioxidant vitamins to prevent serious morbidity associated with preeclampsia, by James M. Roberts, M.D., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development MFMU Network in Bethesda, Md., and colleagues.

"Recruitment at 13 weeks is earlier than other studies that enrolled at an average of 18 weeks and may be especially relevant as there is a burst of oxidative stress with the institution of intervillous blood flow at 10 to 12 weeks' gestation," Roberts and colleagues stated.

"The researchers found no benefit in low-risk nulliparous women," Ghidini said. "Although a small randomized 1999 trial showed that antioxidant vitamins reduced the incidence of preeclampsia by 60 percent, recent larger trials have shown no benefit. The negative findings in the new trial put the issue to rest once and for all."

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Another study conducted by researchers from the Eunice Kennedy Shriver National Institute of Child Health and Human Development MFMU Network -- presented by Mark B. Landon, M.D. -- compared outcomes in 485 women with treated mild gestational diabetes and 473 women with untreated mild gestational diabetes. Although there was no significant difference in composite morbidity between the treated and untreated groups (32.4 percent and 37 percent, respectively), the researchers found that treatment was associated with a lower risk for fetal overgrowth (5.9 percent versus 14.3 percent), shoulder dystocia (1.5 percent versus 4 percent), and cesarean delivery (26.9 percent versus 33.8 percent).

"This study reinforces the need to treat mild gestational diabetes," Ghidini said.

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One of the most newsworthy developments was the presentation of preliminary results showing that a new maternal serum test can accurately detect Down syndrome and other genetic fetal conditions during the first trimester. Developed by Stephen A. Brown of the University of Vermont and medical director of Lenetix, Inc., in Mineola, N.Y., the test relies on the use of methylation-sensitive amplification of fetal nucleic acid markers.

"The technique described by Dr. Brown and his team at Lenetix will create a revolution in prenatal diagnosis," study investigator Allan Fisher, M.D., said in a statement. "This testing will ultimately decrease the number of amniocenteses, and thus reduce the number of miscarriages caused by amniocenteses. It will also help us identify patients who will need an amniocentesis or chorionic villus sampling where we may have missed them before. A better test that produces fewer false positives and negatives drives better patient care, and that's exciting for the future."

The March of Dimes' award-winning study, "The Relationship Between Polymorphisms in the Human Progesterone Receptor and Clinical Response to 17 Alpha-Hydroxyprogesterone Caproate for the Prevention of Recurrent Spontaneous Preterm Birth," was conducted by Tracy Manuck, M.D., and sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development MFMU Network and the University of Utah. The study identified two single-nucleotide polymorphisms in black women and three others in non-black women that predicted the response to progesterone treatment.

"Dr. Manuck's research gives us a tantalizing clue as to why 17 alpha-hydroxyprogesterone caproate works for some women, but not for others," Alan R. Fleischman, M.D., senior vice president and medical director of the March of Dimes, said in a statement. "With further research along these lines, we hope to someday be able to prevent preterm birth from happening in the first place by screening women before they get pregnant, and identifying those whose babies could get a healthy start in life with the help of 17 alpha-hydroxyprogesterone caproate."

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SMFM: Sonogram Predicts Uterine Rupture in Labor Trial

FRIDAY, Jan. 30 (HealthDay News) -- In pregnant women with a prior cesarean delivery, sonographic evaluation of the lower uterine segment can predict the risk of uterine rupture during a trial of labor, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting held Jan. 26 to 31 in San Diego.

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SMFM: 'Rescue Steroids' Benefit Preterm Infants

THURSDAY, Jan. 29 (HealthDay News) -- A "rescue course" of antenatal corticosteroids administered to women at high risk of preterm delivery can significantly improve neonatal outcomes, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting held Jan. 26 to 31 in San Diego.

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Physician's Briefing