- Email: [email protected]
254: Early glucose testing in the obese gravida
Poster Session II
Diabetes, Doppler, Labor, Ultrasound-Imaging
RESULTS: During the study period, 88 diabetics underwent screening during pregnancy. The mean age was 32.6⫾6.5 years, 56% were Latina, and mean BMI was 35⫾9.1. Of those screened, 26%(23/88) were type 1 diabetics, 66% (58/66) had type 2 diabetes and 8%(7/88) had gestational diabetes. 35% of patients had one or more abnormalities on echocardiogram, including increased left atrial diameter in 30% (26/88), LV diastolic dysfunction in 13% (11/88), and moderate left ventricular hypertrophy in 4.5%(4/88). No patients had severe valvular or functional echocardiographic abnormalities. One patient was diagnosed with a myocardial infarction in pregnancy with an ejection fraction of less than 50%. Obesity, years of diabetes, advanced maternal age, and poor glycemic control were not associated with abnormal echocardiographic findings. The only significant factor associated with abnormal echocardiogram was medicated hypertension, which identified 17 of 31 patients with abnormalities (p⫽.001); OR 5.71(2.14-15.25), adjusted OR 9.83 (2.3-41.9). CONCLUSION: Echocardiographic screening for cardiovascular disease in pregnancy based on risk factors including years of diabetes, hypertension, obesity, advanced maternal age and level of glycemic control identifies a low percentage of abnormalities. The majority of abnormalities detected were mild. Treated hypertension was the only single risk factor associated with abnormal echocardiographic findings. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.268
254 Early glucose testing in the obese gravida Danielle Durie1, Amanda Victory1, Kristin Knight1, Brittany Walker1, Katie Somers1, Eva Pressman1, Loralei Thornburg1 1
University of Rochester, Rochester, New York
www.AJOG.org
STUDY DESIGN: We performed a retrospective cohort study of women
who underwent term labor induction from 10/07 through 9/08. One physician group adopted an oxytocin protocol of 1 mU/min increases every 45 minutes (1q45) while remaining groups used increases of 2 mU/min every 30 minutes (2q30). Uterine contractility and fetal heart rate patterns were assessed using CALM Patterns (LMS Medical Montreal, Canada). Mode of delivery, average and maximal oxytocin dose, and duration of oxytocin administration were assessed. Data were analyzed with Mann-Whitney U test for continuous variables and Chi square for categorical variables. Power analysis indicated 500 subjects would detect a 0.10 difference in the incidence of tachysystole with 80% power. RESULTS: 850 patients were identified, and after exclusion for twins, prior cesarean, fetal anomalies, and incomplete data, 539 records were available for analysis (214 in the 1q45 group and 325 in the 2q30 group). There were no differences in incidence of tachysystole (0.15 for 1q45 and 0.20 for 2q30, p⫽0.14) or median episodes of late or variable decelerations between the two groups. The 1q45 group had a longer duration of oxytocin (median 803 vs. 575 minutes, p⫽0.000), but lower average dose (median 5.05 vs. 5.93 mU/min, p⫽0.000) and maximal dose (median 8 vs. 9 mU/min, p⫽0.01). There were no differences between the two groups in rates of overall cesarean delivery or cesarean delivery for fetal indications. CONCLUSION: Increases of oxytocin by 1 mU every 45 rather than 2 mU every 30 minutes did not affect rates of uterine tachysystole, fetal heart rate abnormalities or mode of delivery but did lead to longer inductions. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.270
OBJECTIVE: Gestational diabetes mellitus (GDM) complicates 2-14%
of pregnancies in the US. Recommendations from 2004 advised early glucose evaluation in obese women. We sought to evaluate the rate and results of early glucose screening in morbidly obese women and the overall rate of gestational diabetes in this population. STUDY DESIGN: Electronic records were reviewed for all women with body mass index ⱖ35 without preexisting diabetes from 1/2004 through 12/2008 who delivered at our institution. Women were divided into three groups: class II (BMI 35-39.9), class IIIa (BMI 4044.9) and class IIIb obesity (BMI ⱖ45). Rates and results of early glucose screening (20-24 weeks), routine glucose screening (⬎24 weeks), three hour testing and GDM were compared among groups. RESULTS: Of 1350 women, 359 women were excluded for no available glucose screening results. Of the remaining 991 women (567 class II, 274 IIIa, 150 IIIb), 45 (4.5%) underwent early glucose testing which was not different between groups (3.7%, 4.7%, 7.3%), and 27% had a positive screen (28.6%, 30.8%, 22.2%). 960 women underwent routine screening, with 320 (33%) screening positive (33% each group). Of the 257 who underwent three hour testing, 107 (42%) of patients tested positive with no differences between groups (39%, 40%, 54%). Overall, 172 (17%) of morbidly obese women were diagnosed with diabetes at any point in pregnancy, with no differences between groups (15%, 16%, 19%). CONCLUSION: Few morbidly obese women are undergoing early glucose screening despite recommendations, even though ⬎25% will test positive at early screening. At routine screening, 33% of morbidly obese women screened positive and ⬎40% of those had positive 3 hour testing. Consistent with prior guidelines, early screening for gestational diabetes in the morbidly obese gravida is warranted but is not routinely done in practice.
256 Outcomes of group diabetic care in a hispanic population: the DULCE program Anna Gonzalez1, Michael Gardner2, Nora Doyle1 1 University of Oklahoma School of Community Medicine, Obstetrics and Gynecology, Tulsa, Oklahoma, 2University Of Oklahoma School of Community Medicine, Department of Obstetrics and Gynecology, Tulsa, Oklahoma
OBJECTIVE: The DULCE Program provides comprehensive prenatal
OBJECTIVE: To evaluate the effects of a change in oxytocin administra-
care to diabetic gravidas in a group setting using a multidisciplinary team of physicians, nutritionist, and certified diabetic eductors in a relaxed culturally sensitive setting. We compared the obstetrical outcomes in Hispanic Diabetic (HDM) patients receiving conventional care versus group care that consisted of appropriate medical therapy including diet, oral hypoglycemics and insulin as indicated; as well as nutrition and lifestyle counseling and group social bonding. STUDY DESIGN: Pregnant Diabetic patients at our university hospital diagnosed prenatally were identified. Information on maternal demographics, pregnancy complications, antenatal interventions, and perinatal outcomes were obtained by reviewing the medical records and our perinatal database. Uni and multivariate analyses were performed where appropriate with p ⬍ 0.05 considered significant. RESULTS: In the 2-year period from July 2007 - June 2009, 67 HDM cases were identified. Maternal demographics included age range from 17 – 44, mean parity of 3, Mean EGA 37.6 weeks, birth weight 3270 grams, Median Apgar score 9 (7-10). There were no significant differences between the groups in these variables. Maternal pregnancy complications identified included 0 intrauterine fetal demises, preeclampsia (5). There was a significant difference in mean HgA1C values (5.6% - group care vs. 7.6% - conventional). Moreover, the number of visits in the DULCE program patients was greater vs. conventional care.(12.6 vs. 7.3 p ⬍ 0.001). CONCLUSION: Women in the DULCE program had improved HgA1C values. Furthermore, the DULCE patients attended more prenatal visits than conventional care, perhaps due to higher patient satisfaction Comprehensive care in a group setting including education and frequent visits may translate into better maternal and fetal outcomes particularly in the Hispanic population.
tion practice on maternal and fetal outcomes.
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.271
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.269
255 Two low dose oxytocin induction protocols: effects on tachysystole, fetal heart rate patterns and mode of delivery Danielle Durie1, Nigel Campbell1, Holly Sato1, Joanne Wienschreider1, Ken Edell1, Eva Pressman1 1
University of Rochester Medical Center, Rochester, New York
S106
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Diabetes, Doppler, Labor, Ultrasound-Imaging
RESULTS: During the study period, 88 diabetics underwent screening during pregnancy. The mean age was 32.6⫾6.5 years, 56% were Latina, and mean BMI was 35⫾9.1. Of those screened, 26%(23/88) were type 1 diabetics, 66% (58/66) had type 2 diabetes and 8%(7/88) had gestational diabetes. 35% of patients had one or more abnormalities on echocardiogram, including increased left atrial diameter in 30% (26/88), LV diastolic dysfunction in 13% (11/88), and moderate left ventricular hypertrophy in 4.5%(4/88). No patients had severe valvular or functional echocardiographic abnormalities. One patient was diagnosed with a myocardial infarction in pregnancy with an ejection fraction of less than 50%. Obesity, years of diabetes, advanced maternal age, and poor glycemic control were not associated with abnormal echocardiographic findings. The only significant factor associated with abnormal echocardiogram was medicated hypertension, which identified 17 of 31 patients with abnormalities (p⫽.001); OR 5.71(2.14-15.25), adjusted OR 9.83 (2.3-41.9). CONCLUSION: Echocardiographic screening for cardiovascular disease in pregnancy based on risk factors including years of diabetes, hypertension, obesity, advanced maternal age and level of glycemic control identifies a low percentage of abnormalities. The majority of abnormalities detected were mild. Treated hypertension was the only single risk factor associated with abnormal echocardiographic findings. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.268
254 Early glucose testing in the obese gravida Danielle Durie1, Amanda Victory1, Kristin Knight1, Brittany Walker1, Katie Somers1, Eva Pressman1, Loralei Thornburg1 1
University of Rochester, Rochester, New York
www.AJOG.org
STUDY DESIGN: We performed a retrospective cohort study of women
who underwent term labor induction from 10/07 through 9/08. One physician group adopted an oxytocin protocol of 1 mU/min increases every 45 minutes (1q45) while remaining groups used increases of 2 mU/min every 30 minutes (2q30). Uterine contractility and fetal heart rate patterns were assessed using CALM Patterns (LMS Medical Montreal, Canada). Mode of delivery, average and maximal oxytocin dose, and duration of oxytocin administration were assessed. Data were analyzed with Mann-Whitney U test for continuous variables and Chi square for categorical variables. Power analysis indicated 500 subjects would detect a 0.10 difference in the incidence of tachysystole with 80% power. RESULTS: 850 patients were identified, and after exclusion for twins, prior cesarean, fetal anomalies, and incomplete data, 539 records were available for analysis (214 in the 1q45 group and 325 in the 2q30 group). There were no differences in incidence of tachysystole (0.15 for 1q45 and 0.20 for 2q30, p⫽0.14) or median episodes of late or variable decelerations between the two groups. The 1q45 group had a longer duration of oxytocin (median 803 vs. 575 minutes, p⫽0.000), but lower average dose (median 5.05 vs. 5.93 mU/min, p⫽0.000) and maximal dose (median 8 vs. 9 mU/min, p⫽0.01). There were no differences between the two groups in rates of overall cesarean delivery or cesarean delivery for fetal indications. CONCLUSION: Increases of oxytocin by 1 mU every 45 rather than 2 mU every 30 minutes did not affect rates of uterine tachysystole, fetal heart rate abnormalities or mode of delivery but did lead to longer inductions. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.270
OBJECTIVE: Gestational diabetes mellitus (GDM) complicates 2-14%
of pregnancies in the US. Recommendations from 2004 advised early glucose evaluation in obese women. We sought to evaluate the rate and results of early glucose screening in morbidly obese women and the overall rate of gestational diabetes in this population. STUDY DESIGN: Electronic records were reviewed for all women with body mass index ⱖ35 without preexisting diabetes from 1/2004 through 12/2008 who delivered at our institution. Women were divided into three groups: class II (BMI 35-39.9), class IIIa (BMI 4044.9) and class IIIb obesity (BMI ⱖ45). Rates and results of early glucose screening (20-24 weeks), routine glucose screening (⬎24 weeks), three hour testing and GDM were compared among groups. RESULTS: Of 1350 women, 359 women were excluded for no available glucose screening results. Of the remaining 991 women (567 class II, 274 IIIa, 150 IIIb), 45 (4.5%) underwent early glucose testing which was not different between groups (3.7%, 4.7%, 7.3%), and 27% had a positive screen (28.6%, 30.8%, 22.2%). 960 women underwent routine screening, with 320 (33%) screening positive (33% each group). Of the 257 who underwent three hour testing, 107 (42%) of patients tested positive with no differences between groups (39%, 40%, 54%). Overall, 172 (17%) of morbidly obese women were diagnosed with diabetes at any point in pregnancy, with no differences between groups (15%, 16%, 19%). CONCLUSION: Few morbidly obese women are undergoing early glucose screening despite recommendations, even though ⬎25% will test positive at early screening. At routine screening, 33% of morbidly obese women screened positive and ⬎40% of those had positive 3 hour testing. Consistent with prior guidelines, early screening for gestational diabetes in the morbidly obese gravida is warranted but is not routinely done in practice.
256 Outcomes of group diabetic care in a hispanic population: the DULCE program Anna Gonzalez1, Michael Gardner2, Nora Doyle1 1 University of Oklahoma School of Community Medicine, Obstetrics and Gynecology, Tulsa, Oklahoma, 2University Of Oklahoma School of Community Medicine, Department of Obstetrics and Gynecology, Tulsa, Oklahoma
OBJECTIVE: The DULCE Program provides comprehensive prenatal
OBJECTIVE: To evaluate the effects of a change in oxytocin administra-
care to diabetic gravidas in a group setting using a multidisciplinary team of physicians, nutritionist, and certified diabetic eductors in a relaxed culturally sensitive setting. We compared the obstetrical outcomes in Hispanic Diabetic (HDM) patients receiving conventional care versus group care that consisted of appropriate medical therapy including diet, oral hypoglycemics and insulin as indicated; as well as nutrition and lifestyle counseling and group social bonding. STUDY DESIGN: Pregnant Diabetic patients at our university hospital diagnosed prenatally were identified. Information on maternal demographics, pregnancy complications, antenatal interventions, and perinatal outcomes were obtained by reviewing the medical records and our perinatal database. Uni and multivariate analyses were performed where appropriate with p ⬍ 0.05 considered significant. RESULTS: In the 2-year period from July 2007 - June 2009, 67 HDM cases were identified. Maternal demographics included age range from 17 – 44, mean parity of 3, Mean EGA 37.6 weeks, birth weight 3270 grams, Median Apgar score 9 (7-10). There were no significant differences between the groups in these variables. Maternal pregnancy complications identified included 0 intrauterine fetal demises, preeclampsia (5). There was a significant difference in mean HgA1C values (5.6% - group care vs. 7.6% - conventional). Moreover, the number of visits in the DULCE program patients was greater vs. conventional care.(12.6 vs. 7.3 p ⬍ 0.001). CONCLUSION: Women in the DULCE program had improved HgA1C values. Furthermore, the DULCE patients attended more prenatal visits than conventional care, perhaps due to higher patient satisfaction Comprehensive care in a group setting including education and frequent visits may translate into better maternal and fetal outcomes particularly in the Hispanic population.
tion practice on maternal and fetal outcomes.
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.271
0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.269
255 Two low dose oxytocin induction protocols: effects on tachysystole, fetal heart rate patterns and mode of delivery Danielle Durie1, Nigel Campbell1, Holly Sato1, Joanne Wienschreider1, Ken Edell1, Eva Pressman1 1
University of Rochester Medical Center, Rochester, New York
S106
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009