- Email: [email protected]
411: First trimester hyperuricemia predicts development of gestational diabetes
SMFM Abstracts 409
A SYSTEMATIC TECHNIQUE USING 3D ULTRASOUND PROVIDES A SIMPLE AND RELIABLE MODE TO EVALUATE THE CORPUS CALLOSUM ERAN BORNSTEIN1, ANA MONTEAGUDO1, ROSA SANTOS1, SEAN KEELER1, ILAN E. TIMOR-TRITCSH1, 1New York University School of Medicine, Obstetrics & Gynecology, New York, New York OBJECTIVE: Agenesis of the corpus callosum is a relatively common anomaly occurring in 0.3% to 0.7% of the general population. Routine axial brain views can not visualize the corpus callosum (CC) and meticulous scanning technique in the coronal and sagittal planes are warranted for that purpose. We therefore set out to evaluate a systematic approach using 3D ultrasound to obtain a diagnostic quality evaluation of the CC. STUDY DESIGN: Transabdominal 3D gray scale and power Doppler volumes of the fetal brain were acquired in 70 consecutive healthy fetuses (20-23 weeks’ gestation). Off-line 3D analysis was performed by two of the authors using a rapid systematic approach of volume manipulation on the multiplanar display mode into a standard, symmetrical orientation of the orthogonal planes. Diagnostic quality visualization of the CC (gray scale volume) and the pericallosal artery (PA) (power Doppler volume) on the “perfect median plane” were recorded in a blinded fashion by the two examiners. RESULTS: Using our technique, The “perfect median plane” was successfully obtained in all cases regardless of the initial or acquisition plane. Diagnostic quality images of the CC were recorded by the two examiners, in 98.6% and 91.4% of the cases, respectively. Diagnostic quality images of the PA were recorded by the two examiners in 93.4% and 91.8% of the cases, respectively.
www.AJOG.org 411
FIRST TRIMESTER HYPERURICEMIA PREDICTS DEVELOPMENT OF GESTATIONAL DIABETES S. KATHERINE LAUGHON1, JANET CATOV1, TRACI PROVINS1, JAMES ROBERTS1, ROBIN GANDLEY1, 1University of Pittsburgh, Pittsburgh, Pennsylvania OBJECTIVE: Uric acid is elevated in the 2nd and 3rd trimesters in women with gestational diabetes mellitus (GDM). Hyperuricemia is also a marker of metabolic syndrome in non-pregnant women. Our objective was to demonstrate that pregnant women with elevated first trimester plasma uric acid have an increased risk of developing GDM. STUDY DESIGN: Uric acid was measured in banked plasma samples drawn at ⬍15 weeks gestation from subjects enrolled in the Pregnancy Exposures and Preeclampsia Prevention Study. The primary outcome was GDM, defined by a one hour glucola 200 mg/dL or diagnosed by three hour glucose tolerance test using Carpenter and Coustan criteria. We adjusted for pre-pregnancy body mass index (BMI) and maternal age. Smoking, maternal race, education, and exercise did not significantly contribute to the final model. RESULTS: A total of 1573 samples were available with a mean gestational age of 8.9 ⫾ 2.5 weeks. 73 women (4.6%) developed GDM. Almost half (46.6%) of the women who developed GDM had first trimester uric acid concentrations in the highest quartile. Women with uric acid in the highest quartile (⬎3.57-8.30 mg/dL) had a 3.25-fold increased risk (95%CI: 1.35, 7.83) of developing GDM after adjustment for BMI and age. This effect was dose dependent as risk increased with increasing uric acid quartiles (p⫽0.003). There was no interaction between uric acid and BMI (p⫽0.48). CONCLUSION: First trimester hyperuricemia is associated with an increased risk of developing GDM, independent of BMI. Consideration should be given for early GDM screening in pregnant women with first trimester hyperuricemia. Risk of GDM by uric acid quartiles
CONCLUSION: This systematic technique of manipulating the fetal brain volume on the multiplanar display mode provides an easy and rapid method to obtain the “perfect median plane”, enabling diagnostic visualization of the CC and the PA. Thus, off-line 3D analysis using this technique may improve our ability to expeditiously evaluate the CC, limiting the necessity to perform additional sonographic brain evaluation solely to cases with a suspected brain anomaly. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.438
410
DO PROTEASE INHIBITORS INCREASE PRETERM BIRTHS IN HIV-INFECTED PATIENTS? SHAUNA WILLIAMS1, BART HOLLAND2, ULAS BOZDOGAN1, JESUS ALVAREZ3, JOSEPH APUZZIO1, ARLENE BARDEGUEZ1, 1UMDNJ-New Jersey Medical School, Obstetrics, Gynecology and Women’s Health, Newark, New Jersey, 2 UMDNJ-New Jersey Medical School, Preventive Medicine, Newark, New Jersey, 3 HIMA/San Pablo Hospital, Obstetrics and Gynecology, Caguas, Puerto Rico OBJECTIVE: The effect of protease inhibitors (PIs) on preterm delivery continues to be debated. Our objective was to compare the rates of preterm delivery in HIV-infected patients on a PI-based versus PI-sparing regimen. STUDY DESIGN: This is a retrospective cohort study of all HIV-infected pregnant women who delivered between July 1, 2000 and November 1, 2007. Antiretroviral regimen, viral load, CD4 counts, medical and obstetric complications, gestational age at delivery and birthweight were abstracted. Patients were grouped by PI use during pregnancy. Student=s t-test, Chi-square and Kruskal-Wallis tests were performed. P⬍0.05 was considered significant. Data shown are mean ⫾ standard deviation. RESULTS: There were 129 pregnancies in the PI-group and 59 in the PI-sparing group. There was no difference in age, tobacco exposure, or history of preterm delivery between the two groups, but drug use was higher in the PI-sparing group (p⫽0.04). Entry viral load (copies/mL) and CD4 counts (cells/mm3) in the PI and PI-sparing groups were 42197.01 ⫾ 124524.61 and 377.1 ⫾ 224.0 versus 6928.33 ⫾ 19323.25 and 593.3 ⫾ 270.5, respectively (p⬍0.0001). The overall preterm delivery rate was 27.1% (N⫽51) with no difference between the two groups (27.9 vs 25.4%, p⫽0.72). 28.6% (N⫽14) of those who delivered preterm had a history of preterm birth compared to 8.4% (N⫽11) of those who delivered fullterm (p⫽0.0019). Similarly, patients who delivered preterm had a higher rate of substance use (37.3 vs 19.7%, p⫽0.0128). In a multivariate analysis including obstetric history, drug use, protease inhibitor use and entry CD4, only history of preterm delivery was significant (p⫽0.018). CONCLUSION: History of preterm delivery and substance use were significant factors for preterm birth in this cohort. Contrary to other studies, PIs were not associated with preterm delivery.
UA quartile (max value mg/dL)
GDM n(%)
Adjusted RR (95%CI)
1st (2.48) 2nd (2.97) 3rd (3.57) 4th (8.30)
7 (0.5%) 12 (0.8%) 20 (1.3%) 34 (2.2%)
ref 1.57 (0.61-4.08) 2.37 (0.97-5.83) 3.25 (1.35-7.83)
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.440
412
PREGNANCY OUTCOMES IN PERINATALLY HIV INFECTED WOMEN SUBHA SUNDARAM1, AMANDA COTTER1, 1University of Miami, Miami, Florida OBJECTIVE: Due to advances in therapy, an increasing number of perinatally HIV infected girls are reaching childbearing age and becoming pregnant.These pregnancies can potentially be complicated by advanced stages of disease,complex drug regimens and risk of transmission of drug resistant mutations.The objective of this study is to analyze pregnancy outcomes in women perinatally infected with HIV. STUDY DESIGN: This is a prospective observational study conducted from 2000 to 2008 at a single center. There were 20 pregnancies identified in perinatally HIV infected women who received prenatal care at our clinic. RESULTS: The median age was18 years (range 14-23 yrs).17 women were primigravida and three women were in their second pregnancies. Of the 20 women, 15 received Anti Retroviral Therapy (ART) prior to pregnancy and five were ART naïve. At the first visit of pregnancy, the median viral load was 14400 copies/ml (range:Non Detectable to 42,000 copies/ml).The median CD4 count was 250 cells /mm3 (range:18- 590 cells /mm3).All women received Highly Active Anti Retroviral therapy (HAART) during pregnancy. The viral load at 35 weeks gestation was non detectable in all patients. One patient had chronic hypertension and HIV nephropathy. The pregnancy associated complications noted were mild preeclampsia (n⫽1), obstetric cholestasis (n⫽1) and PPROM at 30 weeks (n⫽1). Of the 20 patients, two transferred out to another state and three are currently pregnant. Among the 15 patients, two elected to terminate the pregnancy. There were no miscarriages or stillbirths. There were 13 liveborn infants (Preterm ⬍37 weeks, n⫽4; Very preterm ⬍ 32 weeks, n⫽1).The mean birth weight was 2700⫾580 grams. Six women underwent cesarean delivery (maternal request, n⫽4and emergency cesarean in labor, n⫽2).All infants received Zidovudine(AZT) in the postpartum period and all are HIV negative CONCLUSION: With early prenatal care and adherence to HAART, perinatal HIV infection is not associated with an increased risk of adverse pregnancy outcome. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.441
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.439
S124
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
A SYSTEMATIC TECHNIQUE USING 3D ULTRASOUND PROVIDES A SIMPLE AND RELIABLE MODE TO EVALUATE THE CORPUS CALLOSUM ERAN BORNSTEIN1, ANA MONTEAGUDO1, ROSA SANTOS1, SEAN KEELER1, ILAN E. TIMOR-TRITCSH1, 1New York University School of Medicine, Obstetrics & Gynecology, New York, New York OBJECTIVE: Agenesis of the corpus callosum is a relatively common anomaly occurring in 0.3% to 0.7% of the general population. Routine axial brain views can not visualize the corpus callosum (CC) and meticulous scanning technique in the coronal and sagittal planes are warranted for that purpose. We therefore set out to evaluate a systematic approach using 3D ultrasound to obtain a diagnostic quality evaluation of the CC. STUDY DESIGN: Transabdominal 3D gray scale and power Doppler volumes of the fetal brain were acquired in 70 consecutive healthy fetuses (20-23 weeks’ gestation). Off-line 3D analysis was performed by two of the authors using a rapid systematic approach of volume manipulation on the multiplanar display mode into a standard, symmetrical orientation of the orthogonal planes. Diagnostic quality visualization of the CC (gray scale volume) and the pericallosal artery (PA) (power Doppler volume) on the “perfect median plane” were recorded in a blinded fashion by the two examiners. RESULTS: Using our technique, The “perfect median plane” was successfully obtained in all cases regardless of the initial or acquisition plane. Diagnostic quality images of the CC were recorded by the two examiners, in 98.6% and 91.4% of the cases, respectively. Diagnostic quality images of the PA were recorded by the two examiners in 93.4% and 91.8% of the cases, respectively.
www.AJOG.org 411
FIRST TRIMESTER HYPERURICEMIA PREDICTS DEVELOPMENT OF GESTATIONAL DIABETES S. KATHERINE LAUGHON1, JANET CATOV1, TRACI PROVINS1, JAMES ROBERTS1, ROBIN GANDLEY1, 1University of Pittsburgh, Pittsburgh, Pennsylvania OBJECTIVE: Uric acid is elevated in the 2nd and 3rd trimesters in women with gestational diabetes mellitus (GDM). Hyperuricemia is also a marker of metabolic syndrome in non-pregnant women. Our objective was to demonstrate that pregnant women with elevated first trimester plasma uric acid have an increased risk of developing GDM. STUDY DESIGN: Uric acid was measured in banked plasma samples drawn at ⬍15 weeks gestation from subjects enrolled in the Pregnancy Exposures and Preeclampsia Prevention Study. The primary outcome was GDM, defined by a one hour glucola 200 mg/dL or diagnosed by three hour glucose tolerance test using Carpenter and Coustan criteria. We adjusted for pre-pregnancy body mass index (BMI) and maternal age. Smoking, maternal race, education, and exercise did not significantly contribute to the final model. RESULTS: A total of 1573 samples were available with a mean gestational age of 8.9 ⫾ 2.5 weeks. 73 women (4.6%) developed GDM. Almost half (46.6%) of the women who developed GDM had first trimester uric acid concentrations in the highest quartile. Women with uric acid in the highest quartile (⬎3.57-8.30 mg/dL) had a 3.25-fold increased risk (95%CI: 1.35, 7.83) of developing GDM after adjustment for BMI and age. This effect was dose dependent as risk increased with increasing uric acid quartiles (p⫽0.003). There was no interaction between uric acid and BMI (p⫽0.48). CONCLUSION: First trimester hyperuricemia is associated with an increased risk of developing GDM, independent of BMI. Consideration should be given for early GDM screening in pregnant women with first trimester hyperuricemia. Risk of GDM by uric acid quartiles
CONCLUSION: This systematic technique of manipulating the fetal brain volume on the multiplanar display mode provides an easy and rapid method to obtain the “perfect median plane”, enabling diagnostic visualization of the CC and the PA. Thus, off-line 3D analysis using this technique may improve our ability to expeditiously evaluate the CC, limiting the necessity to perform additional sonographic brain evaluation solely to cases with a suspected brain anomaly. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.438
410
DO PROTEASE INHIBITORS INCREASE PRETERM BIRTHS IN HIV-INFECTED PATIENTS? SHAUNA WILLIAMS1, BART HOLLAND2, ULAS BOZDOGAN1, JESUS ALVAREZ3, JOSEPH APUZZIO1, ARLENE BARDEGUEZ1, 1UMDNJ-New Jersey Medical School, Obstetrics, Gynecology and Women’s Health, Newark, New Jersey, 2 UMDNJ-New Jersey Medical School, Preventive Medicine, Newark, New Jersey, 3 HIMA/San Pablo Hospital, Obstetrics and Gynecology, Caguas, Puerto Rico OBJECTIVE: The effect of protease inhibitors (PIs) on preterm delivery continues to be debated. Our objective was to compare the rates of preterm delivery in HIV-infected patients on a PI-based versus PI-sparing regimen. STUDY DESIGN: This is a retrospective cohort study of all HIV-infected pregnant women who delivered between July 1, 2000 and November 1, 2007. Antiretroviral regimen, viral load, CD4 counts, medical and obstetric complications, gestational age at delivery and birthweight were abstracted. Patients were grouped by PI use during pregnancy. Student=s t-test, Chi-square and Kruskal-Wallis tests were performed. P⬍0.05 was considered significant. Data shown are mean ⫾ standard deviation. RESULTS: There were 129 pregnancies in the PI-group and 59 in the PI-sparing group. There was no difference in age, tobacco exposure, or history of preterm delivery between the two groups, but drug use was higher in the PI-sparing group (p⫽0.04). Entry viral load (copies/mL) and CD4 counts (cells/mm3) in the PI and PI-sparing groups were 42197.01 ⫾ 124524.61 and 377.1 ⫾ 224.0 versus 6928.33 ⫾ 19323.25 and 593.3 ⫾ 270.5, respectively (p⬍0.0001). The overall preterm delivery rate was 27.1% (N⫽51) with no difference between the two groups (27.9 vs 25.4%, p⫽0.72). 28.6% (N⫽14) of those who delivered preterm had a history of preterm birth compared to 8.4% (N⫽11) of those who delivered fullterm (p⫽0.0019). Similarly, patients who delivered preterm had a higher rate of substance use (37.3 vs 19.7%, p⫽0.0128). In a multivariate analysis including obstetric history, drug use, protease inhibitor use and entry CD4, only history of preterm delivery was significant (p⫽0.018). CONCLUSION: History of preterm delivery and substance use were significant factors for preterm birth in this cohort. Contrary to other studies, PIs were not associated with preterm delivery.
UA quartile (max value mg/dL)
GDM n(%)
Adjusted RR (95%CI)
1st (2.48) 2nd (2.97) 3rd (3.57) 4th (8.30)
7 (0.5%) 12 (0.8%) 20 (1.3%) 34 (2.2%)
ref 1.57 (0.61-4.08) 2.37 (0.97-5.83) 3.25 (1.35-7.83)
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.440
412
PREGNANCY OUTCOMES IN PERINATALLY HIV INFECTED WOMEN SUBHA SUNDARAM1, AMANDA COTTER1, 1University of Miami, Miami, Florida OBJECTIVE: Due to advances in therapy, an increasing number of perinatally HIV infected girls are reaching childbearing age and becoming pregnant.These pregnancies can potentially be complicated by advanced stages of disease,complex drug regimens and risk of transmission of drug resistant mutations.The objective of this study is to analyze pregnancy outcomes in women perinatally infected with HIV. STUDY DESIGN: This is a prospective observational study conducted from 2000 to 2008 at a single center. There were 20 pregnancies identified in perinatally HIV infected women who received prenatal care at our clinic. RESULTS: The median age was18 years (range 14-23 yrs).17 women were primigravida and three women were in their second pregnancies. Of the 20 women, 15 received Anti Retroviral Therapy (ART) prior to pregnancy and five were ART naïve. At the first visit of pregnancy, the median viral load was 14400 copies/ml (range:Non Detectable to 42,000 copies/ml).The median CD4 count was 250 cells /mm3 (range:18- 590 cells /mm3).All women received Highly Active Anti Retroviral therapy (HAART) during pregnancy. The viral load at 35 weeks gestation was non detectable in all patients. One patient had chronic hypertension and HIV nephropathy. The pregnancy associated complications noted were mild preeclampsia (n⫽1), obstetric cholestasis (n⫽1) and PPROM at 30 weeks (n⫽1). Of the 20 patients, two transferred out to another state and three are currently pregnant. Among the 15 patients, two elected to terminate the pregnancy. There were no miscarriages or stillbirths. There were 13 liveborn infants (Preterm ⬍37 weeks, n⫽4; Very preterm ⬍ 32 weeks, n⫽1).The mean birth weight was 2700⫾580 grams. Six women underwent cesarean delivery (maternal request, n⫽4and emergency cesarean in labor, n⫽2).All infants received Zidovudine(AZT) in the postpartum period and all are HIV negative CONCLUSION: With early prenatal care and adherence to HAART, perinatal HIV infection is not associated with an increased risk of adverse pregnancy outcome. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.441
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.439
S124
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008