www.AJOG.org Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues Poster Session III

CONCLUSION: Pregnancy results in an alteration of maternal immunefunction in HIV infected women, particularly CD4 and CD8 Tlymphocytes. Further study is needed to further elucidate theirmechanisms of action and their implications for HIV diseaseprogression.

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Strategies for population-wide genetic carrierscreening: a cost-effectiveness analysisRebecca Weisinger1, Felicia Hawthorne1, Mona Sheikh1,Kenny Wong1, Eric Evans1, Imran Haque1, Reed Pyeritz2,Ramji Srinivasan11Counsyl, South San Francisco, CA, 2Perelman School of Medicine at theUniversity of Pennsylvania, Departments of Medicine and Genetics,Philadelphia, PA

OBJECTIVE: Single-gene disorders affect 1 in 200 births and are aprimary contributor to both pediatric hospitalization and infantmortality. Carrier screens are currently available for hundreds ofthese severe genetic disorders; however, concerns about increasedtesting and genetic counseling costs persist as barriers to the generaluse of expanded screening panels. We present a cost-effectivenessmodel that compares the economic burden of screening, geneticcounseling, and follow-up care to the averted lifetime health carecosts for a population of 1,000,000 with demographics similar to theUS population.STUDY DESIGN: In this study, we evaluated four strategies: (1) pop-ulation-wide screening for cystic fibrosis only; (2) population-widescreening for cystic fibrosis, spinal muscular atrophy, and Fragile Xvia single-gene tests; (3) population-wide screening for cystic fibrosisand spinal muscular atrophy in addition to ethnic-selective screeningusing multiple single-gene assays; and (4) population-wide screeningwith an expanded panel of up to 101 disorders using high-throughput technologies.RESULTS: We find that an expanded panel priced at up to $695 couldyield the same economic benefit as screening for cystic fibrosis onlyat a test price of $300 while resulting in 10 additional averted birthsper year for a population of 1,000,000. Furthermore, our modelshows that genetic counseling represents 1 to 2 percent of screening,counseling, and follow-up costs for strategies using single-gene as-says and that counseling costs for an expanded panel increase by only3 to 7-fold relative to those methods.CONCLUSION: The use of an expanded panel to screen all coupleswho are pregnant or are planning a pregnancy has the potentialto identify a greater number of affected births and return

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increased savings per patient tested than either one or multiplesingle-gene screens, and contrary to expectation, the counselingrequirements for an expanded panel are a minor component oftotal cost.

Comparison of screening strategies

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Social media messaging in pregnancy: how Text4Babycompares to popular smart phone applicationsAdam Lewkowitz1, Betsy O’Donnell1, Sanae Nakagawa1,Juan Vargas1, Yvonne Cheng1, Marya Zlatnik11University of California, San Francisco, Division of Maternal-Fetal Medicine,Department of Obstetrics, Gynecology, and Reproductive Sciences, SanFrancisco, CA

OBJECTIVE: To determine whether content differed between Text4-Baby, an ACOG- and March of Dimes-sponsored free text-messageprogram for pregnancy, and popular smart-phone apps geared forpregnancy.STUDY DESIGN: Researchers enrolled in Text4Baby and downloadedthe four most-popular free pregnancy apps for smart phones as of07/2013. Each program’s content was extracted. 1452 messagesranging from conception to two weeks postpartum were stratifiedinto eight themes of interest, including: weight/nutrition/exercise,depression/anxiety, seeking care, breast feeding, partner roles, cele-brating pregnancy, prevention strategies (vaccinations, contracep-tion, SIDS), and avoidance of toxic exposures (smoking, drugs andenvironmental toxins). Messages related to normal fetal develop-ment or pregnancy symptoms were not analyzed. Two researcherscoded independently before reviewing all codes jointly to ensureconsistency. Chi-square analysis allowed for analysis of statisticallysignificant differences between Text4Baby and the smart-phoneapps.RESULTS: Compared to combined smart-phone-app messaging,Text4Baby was significantly more likely to encourage subscribers toseek care (21.5% compared to 1.4%-7.9%, p<0.0001) and less likelyto mention weight, diet, nutrition, or exercise (5.6% compared to8.5-26.9%, p< 0.001). Text4Baby had fewer messages pertaining topartners but this was not statistically significant. Text4Baby hadmore content geared toward breastfeeding and depression/anxietycompared to smart phone apps, but this was also not statisticallysignificant.CONCLUSION: Text4Baby is currently the only non-smart-phonemessaging program available for pregnant women. To improve itscontent, Text4Baby could decrease the number of messages aboutobtaining care to better emphasize healthy eating, normal weightgain, exercise, and nutrition without increasing the number of textmessages.

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