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71 Diagnosing gestational diabetes: Using a more physiologic glucose solution
268
SPO Abstracts
Januan 199 1
Am
69 Gall MMx , Katz VL, Watson WJ, Hackney ACX , McMurray RG x • FETAL RESPONSES TO MAXIMAL SWIMMING AND CYCLING EXERCISE IN PREGNANCY. University of North Carolina at chapel Hill, Chapel Hill, NC. Fetal responses to maximal exercise were studied during cycling and swimming at 25 and 35 weeks' gestation. The fetal heart rate (FHR) and uterine and umbilical artery wave forms were measured before exercise and during recovery. Six episodes of transient bradycardia occurred after a total of 45 maximal exercise trials. The mean FHR decreased immediately after exercise, then increased at 5-20 minutes after exercise (P < .02). The changes from baseline in FHR were greater after cycling than after swimming. Changes observed in the SID ratio of the umbilical artery could be accounted for by the FHR variations. The SID ratio of the uterine artery was higher after cycling than after swimming (P = .05). Swimming appears to have less effect than cycling on the fetus.
70
INFLUENCE OF PREPREGNANCY HEIGHT AND WEIGHT ON FETAL GROWTH, BIRTHWEIGHT, AND NEONATAL ANTHROPOMETRIC MEASUREMENTS. FL Gaudier x , RL
Goldenberg, SP Cliver x , HJ Hoffman x , RL Copper x , GR Cutterx. University of Alabama at Birmingham, School of Med., Alabama and NICHD. The influence of maternal height (HT) and Body Mass Index (BMI) on birthweight (BWT) and neonatal anthropometric measurements was determined. A total of 1200 singleton term live blrths were evaluated. Fetal growth was measured by serial ultrasound examinations . Multiple regression analyses were performed controlling for maternal age, BMI, HT, race, smoking, infant sex, gestational age, and a previous low BWT infant. Birthweight was significantly correlated with both maternal HT and BMI. Increasing BMI had its greatest influence on BWT in underweight women but had no affect on BWT in overweight women. Newborn crown heel length was strongly influenced by maternal HT while skinfold measurements and the ponderal index were more strongly influenced by the BMI. Head (HC), chest, and abdominal circumferences (AC) were equally influenced by both HT and BMI. Ultrasound data showed a significant influence of the BMI on fetal AC beginning at 30 wks, an inconsistent relationship with HC, but no relationship to the femur length (FL). Maternal HT was significantly related to AC at 18 wks, to HC at 30 wks and to FL at 24 wks. These data indicate that maternal HT and BMI have specif ic effects on different fetal growth measurements, wi th the effects becoming apparent at different gestational ages.
71
J ObSlCl Gynewl
DIAGNOSING GESTATIONAL DIABETES: USING A MORE PHYSIOLOGIC GLUCOSE SOLUTION. xJoyce G. Schwartz, xWllllam T Phillips. Oded Langer. Departments of Pathology, Radiology and OB/GYN, The University of Texas Health Science Center at San Antonio, Texas. We administered a dilute physiologic oral glucose solution (50g glucose in 450ml flUid. 0.62molll) in addition to the standard hyperosmolar oral glucose solution (100g glucose in 300ml fluid, 1 85molll) for oral glucose tolerance testing (OGH) to 102 pregnant women. Each sublect served as her own control The standard oral glucose solution creates delayed gastric emptying and is associated with frequent nausea and vomiting. We believed the physiologic solution would empty rapidly from the stomach and allow the glucose to be absorbed and enter the peripheral circulation in an expeditiOUS manner Peripheral venous blood was sampled for insulin and glucose before the beginning of each test (0 min), then 30, 60, 90 and 120 minutes later for the glucose solutions. Plasma glucose was measured with the Beckman Chemistry Analyzer; insulin With an RIA double antibody technique (Chemicon). Results using the physiologic glucose solution showed. 1) an earlier peaking glucose curve pattern; 2) higher mean glucose excursion values at 30 and 60 minutes (see belowl; 3) no difference in insulin excursion at 30 and 60 minutes; and 4) only rare (8% vs 49%) nausea and/or vomiting: Min. Post-Ingestion Standard Solution Physiologic Solution 30 49 ~ 60 53 58 90 53 33 120 41 14 We conclude that the glucose reaction to the dilute solution represents an improved physiological response . Therefore, a reevaluation of the diagnostic methodology is currently needed.
72 ADENOSINE INDUCES FETAL TACHYCARDIA
Brian J. Koos and lIaleed Doany* Dept of Obstetrics and Gynecology, Nicholas S. Assal i Perinatal Research Laboratory, UCLA School of Medicine, Los Angeles, CA 90024
Adenosine concentrations in tissues increase during hypoxia. Because adenosine is a neuromodulator and a vasoactive agent, it is possible that this purine nucleoside contributes to fetal adaptation during 0 deficiency. The purpose of this study was to determine the eftects of adenosine on fetal heart rate and blood pressure. Five fetal sheep were operated on at about 120 days' gestation (-0.8 term). Catheters were inserted in the right carotid artery, a brachial artery, and the trachea. Experiments were begun at least 4 days after surgery. Adenosine (0.18 mg/min/kg) was infused into the right carotid artery for one hour. This infusion did not significantly affect mean fetal PaC0 or pH but Pa0 was sl ightly reduced (control: 23! 2 mmHg; 2 2 adenosine: 21 ! 2 mmHg). The effects of adenosine on heart rate (HR) and arterial blood pressure (BP) are shown in the table: control
Adenosine infusion 10 20 30
HR (beats/min)
150 !10
169 !15
196· ! 7
195· ! 5
181· !6
BP (mmHg)
42.8 !2.2
42.9 !2.5
41.6 !1.7
40.7 !1.9
42.7 !2.9
~minl
60
• P<0 . 05 lie conclude that adenosine may contribute to hypoxia-related fetal tachycardia.
SPO Abstracts
Januan 199 1
Am
69 Gall MMx , Katz VL, Watson WJ, Hackney ACX , McMurray RG x • FETAL RESPONSES TO MAXIMAL SWIMMING AND CYCLING EXERCISE IN PREGNANCY. University of North Carolina at chapel Hill, Chapel Hill, NC. Fetal responses to maximal exercise were studied during cycling and swimming at 25 and 35 weeks' gestation. The fetal heart rate (FHR) and uterine and umbilical artery wave forms were measured before exercise and during recovery. Six episodes of transient bradycardia occurred after a total of 45 maximal exercise trials. The mean FHR decreased immediately after exercise, then increased at 5-20 minutes after exercise (P < .02). The changes from baseline in FHR were greater after cycling than after swimming. Changes observed in the SID ratio of the umbilical artery could be accounted for by the FHR variations. The SID ratio of the uterine artery was higher after cycling than after swimming (P = .05). Swimming appears to have less effect than cycling on the fetus.
70
INFLUENCE OF PREPREGNANCY HEIGHT AND WEIGHT ON FETAL GROWTH, BIRTHWEIGHT, AND NEONATAL ANTHROPOMETRIC MEASUREMENTS. FL Gaudier x , RL
Goldenberg, SP Cliver x , HJ Hoffman x , RL Copper x , GR Cutterx. University of Alabama at Birmingham, School of Med., Alabama and NICHD. The influence of maternal height (HT) and Body Mass Index (BMI) on birthweight (BWT) and neonatal anthropometric measurements was determined. A total of 1200 singleton term live blrths were evaluated. Fetal growth was measured by serial ultrasound examinations . Multiple regression analyses were performed controlling for maternal age, BMI, HT, race, smoking, infant sex, gestational age, and a previous low BWT infant. Birthweight was significantly correlated with both maternal HT and BMI. Increasing BMI had its greatest influence on BWT in underweight women but had no affect on BWT in overweight women. Newborn crown heel length was strongly influenced by maternal HT while skinfold measurements and the ponderal index were more strongly influenced by the BMI. Head (HC), chest, and abdominal circumferences (AC) were equally influenced by both HT and BMI. Ultrasound data showed a significant influence of the BMI on fetal AC beginning at 30 wks, an inconsistent relationship with HC, but no relationship to the femur length (FL). Maternal HT was significantly related to AC at 18 wks, to HC at 30 wks and to FL at 24 wks. These data indicate that maternal HT and BMI have specif ic effects on different fetal growth measurements, wi th the effects becoming apparent at different gestational ages.
71
J ObSlCl Gynewl
DIAGNOSING GESTATIONAL DIABETES: USING A MORE PHYSIOLOGIC GLUCOSE SOLUTION. xJoyce G. Schwartz, xWllllam T Phillips. Oded Langer. Departments of Pathology, Radiology and OB/GYN, The University of Texas Health Science Center at San Antonio, Texas. We administered a dilute physiologic oral glucose solution (50g glucose in 450ml flUid. 0.62molll) in addition to the standard hyperosmolar oral glucose solution (100g glucose in 300ml fluid, 1 85molll) for oral glucose tolerance testing (OGH) to 102 pregnant women. Each sublect served as her own control The standard oral glucose solution creates delayed gastric emptying and is associated with frequent nausea and vomiting. We believed the physiologic solution would empty rapidly from the stomach and allow the glucose to be absorbed and enter the peripheral circulation in an expeditiOUS manner Peripheral venous blood was sampled for insulin and glucose before the beginning of each test (0 min), then 30, 60, 90 and 120 minutes later for the glucose solutions. Plasma glucose was measured with the Beckman Chemistry Analyzer; insulin With an RIA double antibody technique (Chemicon). Results using the physiologic glucose solution showed. 1) an earlier peaking glucose curve pattern; 2) higher mean glucose excursion values at 30 and 60 minutes (see belowl; 3) no difference in insulin excursion at 30 and 60 minutes; and 4) only rare (8% vs 49%) nausea and/or vomiting: Min. Post-Ingestion Standard Solution Physiologic Solution 30 49 ~ 60 53 58 90 53 33 120 41 14 We conclude that the glucose reaction to the dilute solution represents an improved physiological response . Therefore, a reevaluation of the diagnostic methodology is currently needed.
72 ADENOSINE INDUCES FETAL TACHYCARDIA
Brian J. Koos and lIaleed Doany* Dept of Obstetrics and Gynecology, Nicholas S. Assal i Perinatal Research Laboratory, UCLA School of Medicine, Los Angeles, CA 90024
Adenosine concentrations in tissues increase during hypoxia. Because adenosine is a neuromodulator and a vasoactive agent, it is possible that this purine nucleoside contributes to fetal adaptation during 0 deficiency. The purpose of this study was to determine the eftects of adenosine on fetal heart rate and blood pressure. Five fetal sheep were operated on at about 120 days' gestation (-0.8 term). Catheters were inserted in the right carotid artery, a brachial artery, and the trachea. Experiments were begun at least 4 days after surgery. Adenosine (0.18 mg/min/kg) was infused into the right carotid artery for one hour. This infusion did not significantly affect mean fetal PaC0 or pH but Pa0 was sl ightly reduced (control: 23! 2 mmHg; 2 2 adenosine: 21 ! 2 mmHg). The effects of adenosine on heart rate (HR) and arterial blood pressure (BP) are shown in the table: control
Adenosine infusion 10 20 30
HR (beats/min)
150 !10
169 !15
196· ! 7
195· ! 5
181· !6
BP (mmHg)
42.8 !2.2
42.9 !2.5
41.6 !1.7
40.7 !1.9
42.7 !2.9
~minl
60
• P<0 . 05 lie conclude that adenosine may contribute to hypoxia-related fetal tachycardia.