(P = .007). When we examined only the most common trisomies 13, 18, and 21,an increased risk is also seen with increasing number of SABs (Table). Thesedifferences persisted when controlling for maternal age, but were only statisticalsignificant for 3 or more SABs.

CONCLUSION: An increased risk of karyotypic abnormality is demonstratedin patients who have 3 or more SABs. This study provides novel informationregarding this risk among patients who are presenting for prenatal diagnosis,and can be used to counsel such patients. These results need to be examined inlow risk populations.

Number ofSABs

Rate of tri13, 18, or 21P = .001

OR for tri13, 18, or 21(P value)

OR forany aneuploidy(P value)

0 1.10 % — —1 1.45 % 1.17 (0.084) 1.08 (.081)2 1.56 % 1.28 (0.064) 1.21 (.083)3 1.70 % 1.44 (0.012) 1.48 (.027)

All statistical comparisons are to patients with no prior SABs.

S48 SMFM Abstracts

137 FAS AND FAS LIGAND POLYMORPHISM IN PRETERM LABOR ALEKSANDR FUKS1,LANCE PARTON2, SATYA POLAVARAPU1, DENISE NETTA3, SONYA STRASSBERG2,IOANA GODI2, CHAUR-DONG HSU1, 1New York Medical College - WestchesterMedical Center, Obstetrics and Gynecology, Valhalla, New York, 2New YorkMedical College - Westchester Medical Center, Pediatrics, Valhalla, New York,3UMDNJ - Robert Wood Johnson Medical School / Robert Wood JohnsonUniversity Hospital, Obstetrics and Gynecology, New Brunswick, New Jersey

OBJECTIVE: Fetal inflammatory response has been demonstrated to beinvolved in the pathogenesis of preterm birth (PTB). We have previouslyreported on the role of Fas/Fas ligand (FasL) signal pathway of apoptosis inPTB. Subsequently we investigated the association between polymorphisms atposition -670 in the Fas gene and position -124 in the FasL gene demonstrated inneonatal oral mucosa cells and PTB.

STUDY DESIGN: Thirty seven singleton pregnancies were studied. Nineteenpregnancies were complicated by PTB and eighteen were full-term controls.Buccal swabs were obtained from each neonate and extracted DNA wasanalyzed by polymerase chain reaction-based restriction fragment length poly-morphism for an adenine (A) to guanine (G) substitution at position -670 in theFas promoter gene and at position -124 in the FasL gene. Chi-square andFisher’s exact tests were used for statistical analysis.

RESULTS: There was no difference with respect to race, maternal age andparity between the two groups. Frequencies of Fas -670 AG, -AA, and -GGgenotype in PTB group differed from those in controls, but not statisticallysignificantly (P = .692). Similar findings were observed when frequencies ofFasL -124 AG, -AA, and -GG genotypes in PTB group were compared tocontrols. Neonatal heterozygous AG genotype at position -124 of the FasL genewas observed in 31.6% of PTB patients, as opposed to 11.1% in controls. Nocases of homozygous GG genotype at position -124 of the FasL gene wereobserved in either of the groups.

CONCLUSION: Our data suggest that Fas promoter gene AG polymorphismat position -670 and FasL gene AG polymorphism at position -124 may not besignificantly involved in the Fas / FasL signal pathway of apoptosis associatedwith PTB.

138 THE EFFECT OF MATERNAL PREDNISONE USE ON SECOND-TRIMESTER MATERNALSERUM UNCONJUGATED ESTRIOL LEVELS—RESULTS FROM THE FASTER TRIALSABRINA CRAIGO1, ADAM URATO1, JACOB CANICK2, GINA PELOSO3,FERGAL MALONE4, BRYAN OSHIRO5, DAVID LUTHY6, CHRISTINE H. COMSTOCK7,GARY HANKINS8, RICHARD BERKOWITZ9, SUSAN GROSS10, LORRAINE DUGOFF11,ILAN TIMOR12, STEPHEN CARR2, HONOR WOLFE13, MARY D’LTON4, 1TuftsUniversity, Boston, Massachusetts, 2Brown University, Providence, RhodeIsland, 3DM-Stat, Medford, Massachusetts, 4Columbia University, New York,New York, 5University of Utah Health Sciences Center, Salt Lake City, Utah,6Swedish Medical Center, Seattle, Washington, 7William Beaumont MedicalCenter, Royal Oak, Michigan, 8University of Texas Medical Branch atGalveston, Galveston, Texas, 9Mount Sinai Medical Center, New York, NewYork, 10Albert Einstein College of Medicine, Bronx, New York, 11University ofColorado Health Sciences Center, Denver, Colorado, 12New York University,New York, New York, 13University of North Carolina, Chapel Hill, NorthCarolina

OBJECTIVE: Prednisone is a widely used medication among women ofchildbearing age. Prednisone is known to alter the hypothalamic-pituitaryaxis, thus affecting endogenous maternal hormone levels. This study sought todetermine the association between maternal prednisone use and changes in theunconjugated estriol values measured during second-trimester maternal serumscreening.

STUDY DESIGN: Data were obtained from the FASTER trial. Upon entry intothe trial, patients were asked if they were using prednisone / taking steroids.Quad tests were performed on women from 15 to 18 weeks’gestation and levelsof unconjugated estriol were assessed. Multivariable linear and logistic re-gression were then used to assess the association between prednisone use andlog-transformed unconjugated estriol levels and to estimate the screen positiverate, adjusting for relevant confounders.

RESULTS: 283 women out of 35,231 (0.80%) patients in the trial were takingprednisone. After adjusting for age, race, diabetes, smoking, alcohol use, and thepresence of aneuploidy, the ratio of the median MoM for prednisone users to themedian MoM for non-users is 0.88 (P! .0001.) The age-adjusted screen positiverate in prednisone users was 13.6% (9.9-17.3), versus 8.6% (8.3-8.9) in non-users(P = .002.)

CONCLUSION: Maternal prednisone use is associated with a lower un-conjugated estriol MOM value on maternal serum screening and a significantlyhigher screen positive rate. Further study is needed to determine whether theseeffects are dose dependent, and whether prednisone use should be taken intoconsideration when evaluating the serum Quad screen.

139 HISTORY OF MISCARRIAGE AND INCREASED INCIDENCE OF FETAL ANEUPLOIDY INSUBSEQUENT PREGNANCY KATHERINE BIANCO1, AARON B. CAUGHEY1,BRIAN SHAFFER1, REGINA BERGQUIST1, MARY NORTON1, 1University of California,San Francisco, Department of Obstetrics, Gynecology and ReproductiveSciences, San Francisco, California

OBJECTIVE: The purpose of this study was to examine history of spontaneousabortion (SAB) as a predictor of chromosomal abnormalities.

STUDY DESIGN: This was a retrospective cohort study of all women thatunderwent fetal karyotype analysis with amniocentesis or CVS at a singleprenatal diagnosis referral center. Information on SABs, parity, maternal age,and karyotype were assessed. Univariate and multivariate analyses wereconducted.

RESULTS: A total of 46,939 women were included. We found an increasedrisk of any aneuploidy (trisomy or monosomy) as the number of SABs increased

140 FIRST AND SECOND TRIMESTER DOWN SYNDROME SCREENING MARKERS INPREGNANCIES ACHIEVED THROUGH ASSISTED REPRODUCTIVE TECHNOLOGIES(ART): A FASTER TRIAL STUDY GERALYN LAMBERT-MESSERLIAN1, LORRAINEDUGOFF2, JOHN VIDAVER3, JACOB CANICK1, FERGAL MALONE4, FLINT PORTER5,CHRISTINE COMSTOCK6, DAVID LUTHY7, RADEK BUKOWSKI8, KEITH EDDLEMAN9,SUSAN GROSS10, SABRINA CRAIGO11, ILAN TIMOR12, STEPHEN CARR13,HONOR WOLFE14, MARY D’ALTON4, 1Brown University, Pathology and LaboratoryMedicine, Providence, Rhode Island, 2University of Colorado Health SciencesCenter, Denver, Colorado, 3DM-Stat, Medford, Massachusetts, 4ColumbiaUniversity, New York, New York, 5University of Utah Health SciencesCenter, Salt Lake City, Utah, 6William Beaumont Hospital, Royal Oak,Michigan, 7Swedish Medical Center, Seattle, Washington, 8University ofTexas Medical Branch at Galveston, Galveston, Texas, 9Mount Sinai Schoolof Medicine, New York, New York, 10Albert Einstein College of Medicine,Bronx, New York, 11Tufts University, Boston, Massachusetts, 12New YorkUniversity, New York, New York, 13Women and Infants’ Hospital, Providence,Rhode Island, 14University of North Carolina, Chapel Hill, North Carolina

OBJECTIVE: To determine whether first and second trimester Down syndromescreening markers and screen positive rates are altered in pregnancies achievedby assisted reproductive technologies (ART).

STUDY DESIGN: ART pregnancies were identified as part of the FASTERTrial. Marker levels were expressed as multiple of the median (MoM) values andwere evaluated for five types of ART: IVF with ovulation induction (IVF-OI),IVF with OI and egg donation (IVF-OI-ED), IVF with ED (IVF-ED),intrauterine insemination with OI (IUI-OI), or IUI without OI (IUI). Eachgroup was compared to non-ART controls (n = 37,070) by Mann Whitney Uanalysis.

RESULTS: PAPP-A was lower and free b-hCG was higher in ARTpregnancies, but these trends were not significant and did not occur in EDpregnancies. Second trimester markers were significantly altered in IVF and IUIpregnancies, (lower uE3; higher hCG and inhA). ED pregnancies had higherAFP and inhA. Second, but not first trimester screen positive rates weresignificantly higher than expected, except when ED was used.

First and second trimester median MoM levels and screen positive rates in ARTpatient groups

IVF-OI (278) IUI-OI (323) IUI (247) IVF-OI-ED (59) IVF-ED (56)

NT 1.03 1.02 1.97 0.96 0.96PAPP-A 0.94 0.91* 0.98 1.09 1.00fB-hCG 1.13 1.06 1.08 0.99 1.221T+ (%) 8.6 3.4 6.1 3.5 1.8Expected + (%) 5.5 4.2 4.3 2.5 1.0AFP 1.05 1.04 0.96 1.19* 1.26*uE3 0.94* 0.91* 0.94* 0.95 0.93hCG 1.10 1.12* 1.09 1.09 1.15inhA 1.12* 1.10* 1.09* 1.35* 1.33*2T+ (%) 20.2# 21.2# 19.1# 12.5 7.4Expected + (%) 14.7 11.9 12.3 7.4 3.9

+ = screen positive.* P ! .005 versus control group levels.# P ! .05 versus expected positive rate.

CONCLUSION: These data show for the first time that ART has a greaterimpact on second than first trimester screening, and that inhA levels aremarkedly increased in all types of ART. Adjustment for ART in the secondtrimester screening is warranted but complicated, depending on the type of ARTused.