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537 Diabetes mellitus in women over 35
394
536
SPO Abstracts
ANONYMOUS URINE TOXICOLOGY SCREEN IN AN INNER-CITY PERINATAL CENTER. Mahmoud A. Ismail. M.D., Atef H. Moawad, M.D., PhyLLis L. Jones, R.N., M.P.H., CathLeen Gray, R.S., B.S.N University of Chicago, Chicago, Jl Linois To study the magnitude of substance abuse in an inner-city pregnant popuLation, we surveyed 1,015 pregnant women from June through August 1989. The anonymous urine specimens were ob· tained in conjunction with routine testing done during triage in the birthroom adnitting area. Demographic data was obtained to profi Le the cL ient popuLation. The urine specimens from 199 patients (19.6%) were found to be positive for ilLicit substances. A NIDA certified Laboratory tested for af11)hetamine, opiate, marl Juana, cocaine, barbiturate, phencycL idine (PCP), benzodiazapine and methadone. There were 592 women triaged who subsequently deL ivered, and of these, 119 tested urine toxicoLogy positive. During the study period, 82 women were identified on the UniversaL Data Base (DeL ivery Case Record/OCR) as substance users compared to 119 deL ivered women identified by urine toxicoLogy screen. This wouLd suggest that 30% of substance abusing women may go undetected. One hundred forty five (72.9%) patients were singLe drug users, fifty four (27.1%) were IIlJLtipLe drug users, or a ratio of three to one single, versus rut tiple drug users. Cocaine was positive in 83.3% in IIlJLtipLe drug users and 27.6% of singLe drug users. Mari juana use was found to be high in both categories. ConcLusions: 1. Substance abuse was as high as 19.6% in our popuLation; 2. Marijuana and cocaine were the most frequentLy identified drug in the urine of these patients, and 3. ReL iance on IIsel f reporting" in the absence of a urine screening protocoL, may find that as many as 30% of substance abusing women go undetected.
Januan 1991 .\m J Obstet G) Ill·tol
538
PROTEIN S DEFICIENCY: SUCCESSFUL OUTCOME OF PREGNANCY TREATED WITH ANTEPARTUM HEPARIN Ana Monteagudo, Laxml Baxl, and Edward Bowe Department of Obstetri cs & Gynecology, Sloane HOSPl ta 1 for Women, Col umbl a Presbyteri an Medi ca 1 Center, NY, NY Deficiency in proteln S can lead to a hypercoagulable state caUSl ng recurrent venous thrombosl s. Pratel n S , s a Vl taml n K dependent anticoagul ant. Unll ke other Vl tami n K dependent proteins it does not requlre actlvatlOn by another factor before demonstrating physiologic actlvlty. Pregnancy may exacerbate a preexlsting protein S deflclency and, also, may result ln fetal wastage. Anticoagulation wlth heparln, a potent lnhlbltor of thrombln, can be use safely during pregnancy to prevent venous thrombosl s and carry the pregnancy to term. We report a case of a patlent ln which subcutaneous heparlnlZatlon resulted ln favorable outcome ln two pregnanCles. The patlent lS a 31 y.o G4PI020 wlth a history of a flrst trlmester spontaneous abortion had a fullterm lntrapartum demlse. Following the fetal demlse, a work-up revealed protein S deflclency. The subsequent index pregnancy was uneventful until 31 weeks when a
further drop in the protel n S 1eve 1 was noted. Subcutaneous heparlnlZatlon (7500u tWlce a day) was lnltlated and contlnued throughout the rest of the pregnancy, 1abor, de 11 very and post partum perlod. Labor was induced at 37 weeks for decreased fetal movements resulting in a vaglnal dellvery of a 3610 gms lnfant wlth Apgar scores 9 and 9. The infant dld well. The pl acenta showed ml croscopl c eVl dence of thrombos 1 s. A year later, the patlent had another successful pregnancy treated wlth subcutaneous hepari n. (Currently, another pat 1 ent 1 scant 1 nUl ng pregnancy at 22 weeks gestatlon on 15,OOOu heparln q 8 hourly.) In conclusion, antlcoagulatlon wlth heparln led to a successful outcome of two pregnancl es ina pat 1 ent Wl th known protel n S deflciency.
539 PREDICTING MACROSOMIA WITH THE GLUCOSE 537 DIABETES MELLITUS IN WOMEN OVER 35:0. TOLERANCE TEST. J Owen", CL Winkler, Faustin, R.Shiffman, L.Edwards~ Dept. D Spangler", JC Hauth,~rk". Division of OB/GYN Brookdale Hospital & SUNY-HSC at Maternal-Fetal Medicine, University of Alabama Brooklyn, NY. at Birmingham, Alabama We reviewed our population of Previous studies have shown that patients pregnant diabetics to determine the with only one abnormal value on a 100 g, 3 hr effects of advanced maternal age on oral glucose tolerance test (GTT) have an pregnancy outcome. From January I-June increased risk of macrosomia, Since the GTT, in 30, 1989, 2269 women delivered at our effect, integrates glucose tolerance over time, institution and 100 of these pregnanwe postulated that the sum of the four GTT values may better predict fetal macrosomia than cies were complicated by diabetes would a single abnormal value. In a population (4.4%). The incidence of diabetes was of 415 women who had a GTT, the mean summatlon 62 of 1963(3.2%) in the group younger total was 426 with no abnormal value, 527 wlth than 35 (group A) and 38 of 306 (12.4%) one abnormal value, and 662 with 2 or more in the group 35 or older (group B) abnormal values. Women in the latter group were «p.001). The increased incidence of treated for gestational diabetes. We then diabetes in group B was accounted for determined the incidence of macrosomia in the by a higher incidence of pregestational 309 women who had no (N=230) or one (N=79) (3.3 vs. 1.0%) & gestational (9.1 vs. abnormal value on a GTT. Women with one 2.2%) diabetes. This table summarizes abnormal value had a significantly higher rate pregnancy outcome for the two groups. of macrosomia (birthweight > 90th percentile), GAM (wks) Birth wt cis rate ~ but with only a 28% sensitivity and 85% specificity. Using discriminant analysis, the A 39.0±0.3 3588.5gm* 47% 9.0 cutoff point for the GTT four-value summation B 38.9±0.3 3166.9gm 50% 8.8 was 450. This yielded a sensitivity of 56%, but Conclusion: Diabetes mellitus is more a lower specificity of 58%. We concur that frequently associated with pregnancy in patients with one abnormal GTT value are at women over 35. However, diabetes in the increased risk for macrosomia, but that the older gravida does not carry a greater summation of the four values cannot be used to maternal or neonatal risk than in the accurately predict macrosomia. women less than 35. *P<.05
536
SPO Abstracts
ANONYMOUS URINE TOXICOLOGY SCREEN IN AN INNER-CITY PERINATAL CENTER. Mahmoud A. Ismail. M.D., Atef H. Moawad, M.D., PhyLLis L. Jones, R.N., M.P.H., CathLeen Gray, R.S., B.S.N University of Chicago, Chicago, Jl Linois To study the magnitude of substance abuse in an inner-city pregnant popuLation, we surveyed 1,015 pregnant women from June through August 1989. The anonymous urine specimens were ob· tained in conjunction with routine testing done during triage in the birthroom adnitting area. Demographic data was obtained to profi Le the cL ient popuLation. The urine specimens from 199 patients (19.6%) were found to be positive for ilLicit substances. A NIDA certified Laboratory tested for af11)hetamine, opiate, marl Juana, cocaine, barbiturate, phencycL idine (PCP), benzodiazapine and methadone. There were 592 women triaged who subsequently deL ivered, and of these, 119 tested urine toxicoLogy positive. During the study period, 82 women were identified on the UniversaL Data Base (DeL ivery Case Record/OCR) as substance users compared to 119 deL ivered women identified by urine toxicoLogy screen. This wouLd suggest that 30% of substance abusing women may go undetected. One hundred forty five (72.9%) patients were singLe drug users, fifty four (27.1%) were IIlJLtipLe drug users, or a ratio of three to one single, versus rut tiple drug users. Cocaine was positive in 83.3% in IIlJLtipLe drug users and 27.6% of singLe drug users. Mari juana use was found to be high in both categories. ConcLusions: 1. Substance abuse was as high as 19.6% in our popuLation; 2. Marijuana and cocaine were the most frequentLy identified drug in the urine of these patients, and 3. ReL iance on IIsel f reporting" in the absence of a urine screening protocoL, may find that as many as 30% of substance abusing women go undetected.
Januan 1991 .\m J Obstet G) Ill·tol
538
PROTEIN S DEFICIENCY: SUCCESSFUL OUTCOME OF PREGNANCY TREATED WITH ANTEPARTUM HEPARIN Ana Monteagudo, Laxml Baxl, and Edward Bowe Department of Obstetri cs & Gynecology, Sloane HOSPl ta 1 for Women, Col umbl a Presbyteri an Medi ca 1 Center, NY, NY Deficiency in proteln S can lead to a hypercoagulable state caUSl ng recurrent venous thrombosl s. Pratel n S , s a Vl taml n K dependent anticoagul ant. Unll ke other Vl tami n K dependent proteins it does not requlre actlvatlOn by another factor before demonstrating physiologic actlvlty. Pregnancy may exacerbate a preexlsting protein S deflclency and, also, may result ln fetal wastage. Anticoagulation wlth heparln, a potent lnhlbltor of thrombln, can be use safely during pregnancy to prevent venous thrombosl s and carry the pregnancy to term. We report a case of a patlent ln which subcutaneous heparlnlZatlon resulted ln favorable outcome ln two pregnanCles. The patlent lS a 31 y.o G4PI020 wlth a history of a flrst trlmester spontaneous abortion had a fullterm lntrapartum demlse. Following the fetal demlse, a work-up revealed protein S deflclency. The subsequent index pregnancy was uneventful until 31 weeks when a
further drop in the protel n S 1eve 1 was noted. Subcutaneous heparlnlZatlon (7500u tWlce a day) was lnltlated and contlnued throughout the rest of the pregnancy, 1abor, de 11 very and post partum perlod. Labor was induced at 37 weeks for decreased fetal movements resulting in a vaglnal dellvery of a 3610 gms lnfant wlth Apgar scores 9 and 9. The infant dld well. The pl acenta showed ml croscopl c eVl dence of thrombos 1 s. A year later, the patlent had another successful pregnancy treated wlth subcutaneous hepari n. (Currently, another pat 1 ent 1 scant 1 nUl ng pregnancy at 22 weeks gestatlon on 15,OOOu heparln q 8 hourly.) In conclusion, antlcoagulatlon wlth heparln led to a successful outcome of two pregnancl es ina pat 1 ent Wl th known protel n S deflciency.
539 PREDICTING MACROSOMIA WITH THE GLUCOSE 537 DIABETES MELLITUS IN WOMEN OVER 35:0. TOLERANCE TEST. J Owen", CL Winkler, Faustin, R.Shiffman, L.Edwards~ Dept. D Spangler", JC Hauth,~rk". Division of OB/GYN Brookdale Hospital & SUNY-HSC at Maternal-Fetal Medicine, University of Alabama Brooklyn, NY. at Birmingham, Alabama We reviewed our population of Previous studies have shown that patients pregnant diabetics to determine the with only one abnormal value on a 100 g, 3 hr effects of advanced maternal age on oral glucose tolerance test (GTT) have an pregnancy outcome. From January I-June increased risk of macrosomia, Since the GTT, in 30, 1989, 2269 women delivered at our effect, integrates glucose tolerance over time, institution and 100 of these pregnanwe postulated that the sum of the four GTT values may better predict fetal macrosomia than cies were complicated by diabetes would a single abnormal value. In a population (4.4%). The incidence of diabetes was of 415 women who had a GTT, the mean summatlon 62 of 1963(3.2%) in the group younger total was 426 with no abnormal value, 527 wlth than 35 (group A) and 38 of 306 (12.4%) one abnormal value, and 662 with 2 or more in the group 35 or older (group B) abnormal values. Women in the latter group were «p.001). The increased incidence of treated for gestational diabetes. We then diabetes in group B was accounted for determined the incidence of macrosomia in the by a higher incidence of pregestational 309 women who had no (N=230) or one (N=79) (3.3 vs. 1.0%) & gestational (9.1 vs. abnormal value on a GTT. Women with one 2.2%) diabetes. This table summarizes abnormal value had a significantly higher rate pregnancy outcome for the two groups. of macrosomia (birthweight > 90th percentile), GAM (wks) Birth wt cis rate ~ but with only a 28% sensitivity and 85% specificity. Using discriminant analysis, the A 39.0±0.3 3588.5gm* 47% 9.0 cutoff point for the GTT four-value summation B 38.9±0.3 3166.9gm 50% 8.8 was 450. This yielded a sensitivity of 56%, but Conclusion: Diabetes mellitus is more a lower specificity of 58%. We concur that frequently associated with pregnancy in patients with one abnormal GTT value are at women over 35. However, diabetes in the increased risk for macrosomia, but that the older gravida does not carry a greater summation of the four values cannot be used to maternal or neonatal risk than in the accurately predict macrosomia. women less than 35. *P<.05