M.H.L. van der Wal

Increased maternal BMI is associated with infant wheezing in early life: a prospective cohort study.

Rates of obesity are increasing in women of child bearing age with negative impacts on maternal and offspring health. Emerging evidence suggests in utero origins of respiratory health in offspring of obese mothers but mechanisms are unknown. Changes in maternal cortisol levels are one potential factor as cortisol levels are altered in obesity and cortisol is separately implicated in development of offspring wheeze. We aimed to assess whether increased pre-pregnancy maternal body mass index (BMI) was associated with offspring early life wheezing, and whether this was mediated by altered cortisol levels in the mother. In a prospective community-based cohort (Amsterdam Born Children and their Development cohort), women completed questionnaires during pregnancy and at 3-5 months post-delivery regarding self-history of asthma and atopy, and of wheezing of their offspring (n=4860). Pre-pregnancy BMI was recorded and serum total cortisol levels were measured in a subset of women (n=2227) at their first antenatal visit. A total of 20.2% (n=984) women were overweight or obese and 10.3% reported wheezing in their offspring. Maternal BMI was associated with offspring wheezing (1 unit (kg/m2) increase, OR: 1.03; 95% CI: 1.00-1.05), after correction for confounders. Although maternal cortisol levels were lower in overweight mothers and those with a history of asthma, maternal cortisol levels did not mediate the increased offspring wheezing. Pre-pregnancy BMI impacts on baby wheezing, which is not mediated by lower cortisol levels. As the prevalence of obesity in women of child-bearing age is increasing, further studies are needed to investigate modifiable maternal factors to avoid risk of wheezing in young children.

1242: Coordinating Study Evaluating Outcomes of Advising and Counselling in Heart Failure (COACH): Methodology and Design

Purpose: In seeking evidence to support the local practice of keeping patients on bed rest fo r 6 h following cardiac catheterisation and percutaneous coronary intervention (PCI), very little literature was found. In order to establish the safety of reducing bed rest, practice was benchmarked and audited. Methods: A benchmarking exercise was undertaken against nine other cardiac centres, which revealed an average bed rest time of 5–6 h. A baseline audit of current practice was conducted to establish complication rates related to femoral wound site and length of bed rest. Using a convenience sample of consecutive patients, a total number of 200 data sets (195 complete ) were obtained using a specifically designed audit tool. The audit was repeated following a reduction in bed rest t o 3 h and a further 200 data sets were collected(176 complete ) using the same tool. Results: 358 (96.2%) of cases used six French sheath and only 120(32.3%) used an arterial closure device, all others used manual compression (average time s10 min) to achieve haemostasis. Similar ratios of male yfemale and diagnosticyinterventional cases were documented pre and post change. Numbers of haematomas reduced from 29 prechange(14.8%) to 19 post-change(10.8%). Number of oozing or bleeding incidents increased from 5 (2.6%) to 11 (6.3%). Conclusion: Femoral wound site complication rates were not significantly affected by reducing bed rest time for diagnostic or interventional procedures. Practice can now be based on best available evidence thus ensuring high standards of care.