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125 Anonymous Drug Screening of Prenatal Patients by Paired Urine Collection and Drug History
314
125
SPO Abstracts
January 1992 Am J Obstet Gynecol
ANONYMOUS DRUG SCREENING OF PRENATAL PATIENTS BY PAIRED URINE COLLECTION AND DRUG HISTORY. CL Lowery, C Crone,x R Kirby,xJ Valentine. x Departments of OB/GYN and Pediatrics, the University of Arkansas for Medical Sciences. Little Rock, Arkansas. Concerns over legal ramifications and confidentiality imposed by universal urine drug screening prompted a study to compare urine screening to a nurse-administered drug screening form. During a 30 day period all patients (N=386) receiving prenatal care in the outpatient clinics were screened by both. Urine (collected anonymously) was analyzed by enzyme multiplied immunoassay technique (EMIT) for benzod iazepi ne, rna rijua na, coca i ne, opia tes, and amphetamines. Smokin& correlated most with urine results (sensitivity: 83.3 Yo, positive predictive value: 20.7%). Only 23.3% of women testing positive admitted current use; of those admitting to current use, only 50% tested positive. Since urine screening alone will miss users, nurse- administered questionnaires offer a reasonable alternative to universal urine screening.
127
OH Insulin-dependent diabetic women are considered at high ri sk for prenatal camp 1 i cat; ons of pregnancy; however. sound descri pt i ve data are scarce and most suffer methodo 1ogi c drawbacks. In order to establ i sh the actual rates of these complications in our diabetic population and to improve our abi 1 i ty to provi de pat i ents wi th prenata 1 counsel i ng, we retrospectively studied 254 insulin-dependent diabetic women (White classes B-RT) enrolled in our multidisciplinary program of diabetes in pregnancy prior to 20 weeks' gestation and fa 11 owed every 1-2 weeks throughout pregnancy. Goals of glycemic control were fasting blood glucose < 100 mg/dl and 90 minutes postprandial blood glucose < 140 mg/dl. A control group of 508 non-,diabetic women were randomly selected from the obstetric population enrolled in the hospital's prenatal cl inics prior to 20 weeks' gestation, and matched to the diabetic group (ratio 2:1) by age, race, and parity. Diabetic patients had significantly higher rates of preeclampsia (34% vs. 7.7%; p<.OOI), polyhydramnios (31% vs, 0.6%; p<.OOl), pyelonephritis (4.1% vs. 1.4%; p<.03), meconium stained amniotic fluid (11.4% vs. 4.5%; p<.OOI), and spontaneous preterm deli very (12.4% vs. 7.3%; p<. 05) . No difference was found in the rate of premature rupture of membranes. Preeclampsia and polyhydramnios were associated with microvascular disease and higher mid-trimester glycohemaglobin concentrat ions. We cone 1 ude that the rate of prenatal comp 1; cat; ons of pregnancy ; s indeed increased in i nsu 1 i ndependent di abet i c pregnanci es. We specul ate that the factors predi sposi ng to such camp 1 i cat ions are already estab 1 i shed by m; d-pregnancy and that early gl ycem; c cant ra 1 may be requi red to decrease thei r frequency.
(03. Eo)
Ii'. 7'
(25.
(21
126
~)
(32. B)
THE EFFECT Of IllIITlIIUOOS AlII PULSE COCAINE EXPOSURE 011 EIIlOTHELlAL CELLS Of IILIWI lMIlLlCAL COIID D.S. Mastrog;annisX, \,I.F. O'Brien. Depts. of DB/GYN at TefTl>le University School of Medicine, Phila., PA, and University of South Florida College of Medicine, Tarrpa, Flo
There is an apparent association between cocaine abuse and It has been postulated that some of the adverse effects of cocaine usage in pregnancy may be due to a disturbance of the endothelillR with a secondary reduction in the release of vasodi lstory prostaglandins. We have recently shown (SCI, 1991, Abstract #3) that cocaine decreases prostacycl in production when pharmacological doses of cocaine are added in hunan urbilical vein endotheliaL cell (HUVEC) culture. In the present study, we examined the effect of low dose cocaine concentrations and for variable time periods in a continuous and puLsed in vitro modeL. Confluent cultures of hlmBn urbi l ical cord endothel ial cells, in 24 well plates were incubated wi th cul ture mediun containing 0, 250, 500 ng/ml of cocaine for 6 days, 24 hr. a day in the continuous experiment and 2 hr. a day in the pulsed one. The rnediLm was changed dai ly and was assayed for 6 keto-PGF 1a the stable metabolite of prostacylin (PGI 2 ' by RtA. RESULTS: 6 Keto PGF 1a ~ adverse perinatal outcome.
Cocaine Day 1 Day 3 Day 4 Day 5 Day 6
0 448 285 399 313 408
PULSE 250 431 283 379 322 446
500 410 257 327 294 294
~
NS NS NS NS NS
0 619 478 449 304 347
CONTINUOUS 250 500 476 535 508 546 464 388 395 381 361 403
~
NS NS NS NS NS
CONCLUSIONS: Cocaine in low doses and variable time periods did not affect the production of prostacycLin when incubated with HUVEC in our in vitro model. These data suggest that PGtz-mediated adverse perinatal cooplications might require higher doses and thus greater prenatal surveillance is warranted.
PRENATAL COMPLICATIONS IN INSULIN-DEPENDENT DIABETIC PREGNANCIES. B. Rosenn, M. Miodovnik, J. Khoury: T.A, Siddiqi, Dept. Ob/Gyn, Univ. Cincinnati Med. Ctr., Cincinnati,
128
RISK FACTORS FOR INTRAUTERINE FETAL DEATH RL Copper', RL Goldenberg, MD DuBard', RO Davis. The University of Alabama at Birmingham, Birmingham, Alabama. Risk factors and medical origins of 403 stillbirths which occurred in 5 perinatal centers from 1982-86 were studied. The population included 34,351 births of women screened as part of the March of Dimes Multicenter Pre term Birth Prevention Trial, Stillbirth (SB:Apgar=O at 1 and 5 min at ~ 20 wks GA) occurred in 1.2% of all births. 51% of SBs occurred before 28 wks and only 18% occurred at term, Blacks had an increased risk of SB compared to whites (RR 1.5, p< .001) and Hispanics had a reduced risk (RR .7, p<. 05) . Work, parity, and age < 17 were not associated with SB, but age >35 (RR 2.2, p<.001) and single marital status (RR 1.7, p<,001) were associated. Thin women did not have increased risk of SB but women >85kg had a RR of 2.4 (p<.001). Both prior spontaneous (RR 1.95, p<,001) and indicated PTDs (RR 3.2, p<.001) were associated with SB. preeclampsia resulted in no increased risk, yet the RR of SB related to chronic hypertension was 2,1 (p<. 001). Class A Diabetes (DM) had no increased risk while the RR of SB in Class B-R DM was 2.1 (p=0,05), Conditions resulting in the highest RR of SB were hemoglobinopathies, (7.2, p<.001), Rh sensitization (4,4 p <0.01), and abrupt ion (14,9, p<,001). These data may assist in identifying a fetus at risk for SB and provide data upon which to base studies aimed at reducing fetal death.
125
SPO Abstracts
January 1992 Am J Obstet Gynecol
ANONYMOUS DRUG SCREENING OF PRENATAL PATIENTS BY PAIRED URINE COLLECTION AND DRUG HISTORY. CL Lowery, C Crone,x R Kirby,xJ Valentine. x Departments of OB/GYN and Pediatrics, the University of Arkansas for Medical Sciences. Little Rock, Arkansas. Concerns over legal ramifications and confidentiality imposed by universal urine drug screening prompted a study to compare urine screening to a nurse-administered drug screening form. During a 30 day period all patients (N=386) receiving prenatal care in the outpatient clinics were screened by both. Urine (collected anonymously) was analyzed by enzyme multiplied immunoassay technique (EMIT) for benzod iazepi ne, rna rijua na, coca i ne, opia tes, and amphetamines. Smokin& correlated most with urine results (sensitivity: 83.3 Yo, positive predictive value: 20.7%). Only 23.3% of women testing positive admitted current use; of those admitting to current use, only 50% tested positive. Since urine screening alone will miss users, nurse- administered questionnaires offer a reasonable alternative to universal urine screening.
127
OH Insulin-dependent diabetic women are considered at high ri sk for prenatal camp 1 i cat; ons of pregnancy; however. sound descri pt i ve data are scarce and most suffer methodo 1ogi c drawbacks. In order to establ i sh the actual rates of these complications in our diabetic population and to improve our abi 1 i ty to provi de pat i ents wi th prenata 1 counsel i ng, we retrospectively studied 254 insulin-dependent diabetic women (White classes B-RT) enrolled in our multidisciplinary program of diabetes in pregnancy prior to 20 weeks' gestation and fa 11 owed every 1-2 weeks throughout pregnancy. Goals of glycemic control were fasting blood glucose < 100 mg/dl and 90 minutes postprandial blood glucose < 140 mg/dl. A control group of 508 non-,diabetic women were randomly selected from the obstetric population enrolled in the hospital's prenatal cl inics prior to 20 weeks' gestation, and matched to the diabetic group (ratio 2:1) by age, race, and parity. Diabetic patients had significantly higher rates of preeclampsia (34% vs. 7.7%; p<.OOI), polyhydramnios (31% vs, 0.6%; p<.OOl), pyelonephritis (4.1% vs. 1.4%; p<.03), meconium stained amniotic fluid (11.4% vs. 4.5%; p<.OOI), and spontaneous preterm deli very (12.4% vs. 7.3%; p<. 05) . No difference was found in the rate of premature rupture of membranes. Preeclampsia and polyhydramnios were associated with microvascular disease and higher mid-trimester glycohemaglobin concentrat ions. We cone 1 ude that the rate of prenatal comp 1; cat; ons of pregnancy ; s indeed increased in i nsu 1 i ndependent di abet i c pregnanci es. We specul ate that the factors predi sposi ng to such camp 1 i cat ions are already estab 1 i shed by m; d-pregnancy and that early gl ycem; c cant ra 1 may be requi red to decrease thei r frequency.
(03. Eo)
Ii'. 7'
(25.
(21
126
~)
(32. B)
THE EFFECT Of IllIITlIIUOOS AlII PULSE COCAINE EXPOSURE 011 EIIlOTHELlAL CELLS Of IILIWI lMIlLlCAL COIID D.S. Mastrog;annisX, \,I.F. O'Brien. Depts. of DB/GYN at TefTl>le University School of Medicine, Phila., PA, and University of South Florida College of Medicine, Tarrpa, Flo
There is an apparent association between cocaine abuse and It has been postulated that some of the adverse effects of cocaine usage in pregnancy may be due to a disturbance of the endothelillR with a secondary reduction in the release of vasodi lstory prostaglandins. We have recently shown (SCI, 1991, Abstract #3) that cocaine decreases prostacycl in production when pharmacological doses of cocaine are added in hunan urbilical vein endotheliaL cell (HUVEC) culture. In the present study, we examined the effect of low dose cocaine concentrations and for variable time periods in a continuous and puLsed in vitro modeL. Confluent cultures of hlmBn urbi l ical cord endothel ial cells, in 24 well plates were incubated wi th cul ture mediun containing 0, 250, 500 ng/ml of cocaine for 6 days, 24 hr. a day in the continuous experiment and 2 hr. a day in the pulsed one. The rnediLm was changed dai ly and was assayed for 6 keto-PGF 1a the stable metabolite of prostacylin (PGI 2 ' by RtA. RESULTS: 6 Keto PGF 1a ~ adverse perinatal outcome.
Cocaine Day 1 Day 3 Day 4 Day 5 Day 6
0 448 285 399 313 408
PULSE 250 431 283 379 322 446
500 410 257 327 294 294
~
NS NS NS NS NS
0 619 478 449 304 347
CONTINUOUS 250 500 476 535 508 546 464 388 395 381 361 403
~
NS NS NS NS NS
CONCLUSIONS: Cocaine in low doses and variable time periods did not affect the production of prostacycLin when incubated with HUVEC in our in vitro model. These data suggest that PGtz-mediated adverse perinatal cooplications might require higher doses and thus greater prenatal surveillance is warranted.
PRENATAL COMPLICATIONS IN INSULIN-DEPENDENT DIABETIC PREGNANCIES. B. Rosenn, M. Miodovnik, J. Khoury: T.A, Siddiqi, Dept. Ob/Gyn, Univ. Cincinnati Med. Ctr., Cincinnati,
128
RISK FACTORS FOR INTRAUTERINE FETAL DEATH RL Copper', RL Goldenberg, MD DuBard', RO Davis. The University of Alabama at Birmingham, Birmingham, Alabama. Risk factors and medical origins of 403 stillbirths which occurred in 5 perinatal centers from 1982-86 were studied. The population included 34,351 births of women screened as part of the March of Dimes Multicenter Pre term Birth Prevention Trial, Stillbirth (SB:Apgar=O at 1 and 5 min at ~ 20 wks GA) occurred in 1.2% of all births. 51% of SBs occurred before 28 wks and only 18% occurred at term, Blacks had an increased risk of SB compared to whites (RR 1.5, p< .001) and Hispanics had a reduced risk (RR .7, p<. 05) . Work, parity, and age < 17 were not associated with SB, but age >35 (RR 2.2, p<.001) and single marital status (RR 1.7, p<,001) were associated. Thin women did not have increased risk of SB but women >85kg had a RR of 2.4 (p<.001). Both prior spontaneous (RR 1.95, p<,001) and indicated PTDs (RR 3.2, p<.001) were associated with SB. preeclampsia resulted in no increased risk, yet the RR of SB related to chronic hypertension was 2,1 (p<. 001). Class A Diabetes (DM) had no increased risk while the RR of SB in Class B-R DM was 2.1 (p=0,05), Conditions resulting in the highest RR of SB were hemoglobinopathies, (7.2, p<.001), Rh sensitization (4,4 p <0.01), and abrupt ion (14,9, p<,001). These data may assist in identifying a fetus at risk for SB and provide data upon which to base studies aimed at reducing fetal death.