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741: Middle cerebral artery pulsatility index in fetuses with congenital cardiac abnormalities
Poster Session V
ajog.org 741 Middle cerebral artery pulsatility index in fetuses with congenital cardiac abnormalities Ana Tobiasz1, Jacques Samson1, Mauro Schenone1, Norman Meyer1, Luis C. Gomez1, Giancarlo Mari1 1
University of Tennessee Health Science Center, Memphis, TN
OBJECTIVE: It is a controversial issue whether fetal cerebral blood
flow is altered in cases of congenital cardiac disease, as measured by middle cerebral artery (MCA) Doppler indices. Several studies have reported a decreased MCA pulsatility index (PI), suggesting a brain sparing effect, in specific congenital cardiac lesions, including hypoplastic left heart. However, it is not clear whether intra-uterine growth restricted (IUGR) fetuses were included in the analysis. We aimed to determine if there is a change in MCA PI in cases of congenital heart disease at our center. STUDY DESIGN: This is a retrospective study. 205 fetuses with cardiac anomalies represented our study population. After excluding for aneuploidy, other genetic syndromes, IUGR fetuses, multiple gestations, and extra-cardiac anomalies, 44 patients with MCA PI available were included. RESULTS: Gestational age ranged from 21 weeks 1 day to 39 weeks 2 days. The cases of fetal cardiac anomalies included are listed in Table 1. Six of 44 cases (13.6%) demonstrated decreased MCA PI as compared to the gestational-age-matched reference ranges, which our group has previously published (Table 1). CONCLUSION: In our study population, only 13.6% of the cases had an abnormal MCA PI. Further studies are needed to determine whether there is a different prognosis between the two groups.
during the 6-8 month postpartum period. We investigated their breastfeeding conditions at 6-8 weeks and 6 months postpartum using a questionnaire. We defined intensive breastfeeding (IBF) as a condition in which breastfeeding accounted for approximately 80100% of the infant’s nutritional intake. All other breastfeeding conditions were defined as non-intensive breastfeeding (non-IBF). We performed an OGTT at 6-8 weeks and 6-8 months postpartum, at which time we measured both plasma glucose and serum insulin, and investigated the effect of breastfeeding on a homeostasis model of assessment of insulin resistance (HOMA-IR). RESULTS: Eighty-eight women with GDM during their index pregnancy were included. Among these women, we found 79% and 63% were in the IBF group at 6-8 weeks and 6 months postpartum, respectively. The HOMA-IR in the IBF group were lower at 6-8 months postpartum than those in the non-IBF group after adjusting for pre-pregnancy obesity, weight gain during pregnancy, and postpartum weight change (p¼0.0005) (Table). CONCLUSION: Intensive breastfeeding for at least 6 months postpartum has the effect of enhancing insulin sensitivity, which is independent of obesity and postpartum weight change in Japanese women with GDM.
Table 1. Congenital cardiac anomalies and rate of abnormal MCA PI.
18
22%
1
1
100%
743 Cost-effectiveness of continuous glucose monitoring vs self-monitoring of blood glucose in women with pregestational diabetes
1
8
12.5%
Brenda Niu1, Amir Aviram2, Amy Valent1, Aaron B. Caughey1
Hypoplastic Right Heart
0
1
0%
Tetralogy of Fallot
0
1
0%
1 Oregon Health & Science University, Portland, OR, 2Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel
Double Outlet Right Ventricle
Anomaly
Decreased MCA PI Total cases Percentage
Hypoplastic Left Heart
4
Ebstein's Anomaly ASD/VSD
0
4
0%
Transposition of the Great Vessels 0
2
0%
Double Aortic Arch
0
1
0%
Truncus Arteriosus
0
2
0%
Tricuspid Regurgitation
0
1
0%
Tortuous DA
0
3
0%
Dilated Coronary Sinus
0
1
0%
Abnormal Aortic Arch
0
1
0%
Total
6
44
13.6%
742 The effect of intensive breastfeeding at 6-8 months postpartum on insulin resistance in Japanese women with gestational diabetes Ichiro Yasuhi1, Tomoko Soda1, Hiroshi Yamashita1, Atsuko Urakawa1, Mihoko Izumi1, Yasushi Umezaki1, Yukari Kugishima1 1
NHO Nagasaki Medical Center, Omura-City, Japan
OBJECTIVE: Breastfeeding has a protective effect against the future
development of diabetes in women with gestational diabetes (GDM). However, the mechanism underlying this effect is not clear. We investigated insulin sensitivity during the 6-8 month postpartum period in women with GDM. STUDY DESIGN: The study included women with GDM who underwent at least one postpartum 75g oral glucose tolerance test (OGTT)
OBJECTIVE: Pregestational diabetes mellitus complicates approximately 1-2% of pregnancies. While current guidelines recommend self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM) provides real-time measurements of glucose levels and may improve glycemic control. We sought to determine whether it is cost effective to use CGM rather than SMBG in women with pregestational diabetes. STUDY DESIGN: A cost-effectiveness model was built using TreeAge to compare outcomes of SMBG vs CGM. The model was constructed with probabilities, costs, and utilities derived from the literature, and results were extrapolated in a theoretical cohort of 120,000 women, representing the number of women with pregestational diabetes per year. The primary outcome was cost per quality-adjusted life year (QALY) with a cost-effectiveness threshold at $100,000/QALY. Secondary outcomes included preeclampsia, macrosomia, cesarean delivery, intrauterine fetal demise, infant death, brachial plexus injury (BPI), and hyperbilirubinemia. Sensitivity analyses to vary model inputs were used to determine robustness of results. RESULTS: When compared to SMBG in our theoretical cohort, CGM led to 27 fewer cases of permanent BPI and 374 fewer cases of transient BPI at an additional cost of $299,269,200. Thus, our model showed that while CGM is more effective than SMBG, CGM is more expensive with an incremental cost-effectiveness ratio (ICER) of $724,324 per QALY. Given our willingness to pay threshold of $100,000 per QALY, CGM is therefore not cost effective. Our baseline assumption for the cost of CGM was $3,900 per pregnancy, and
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S389
ajog.org 741 Middle cerebral artery pulsatility index in fetuses with congenital cardiac abnormalities Ana Tobiasz1, Jacques Samson1, Mauro Schenone1, Norman Meyer1, Luis C. Gomez1, Giancarlo Mari1 1
University of Tennessee Health Science Center, Memphis, TN
OBJECTIVE: It is a controversial issue whether fetal cerebral blood
flow is altered in cases of congenital cardiac disease, as measured by middle cerebral artery (MCA) Doppler indices. Several studies have reported a decreased MCA pulsatility index (PI), suggesting a brain sparing effect, in specific congenital cardiac lesions, including hypoplastic left heart. However, it is not clear whether intra-uterine growth restricted (IUGR) fetuses were included in the analysis. We aimed to determine if there is a change in MCA PI in cases of congenital heart disease at our center. STUDY DESIGN: This is a retrospective study. 205 fetuses with cardiac anomalies represented our study population. After excluding for aneuploidy, other genetic syndromes, IUGR fetuses, multiple gestations, and extra-cardiac anomalies, 44 patients with MCA PI available were included. RESULTS: Gestational age ranged from 21 weeks 1 day to 39 weeks 2 days. The cases of fetal cardiac anomalies included are listed in Table 1. Six of 44 cases (13.6%) demonstrated decreased MCA PI as compared to the gestational-age-matched reference ranges, which our group has previously published (Table 1). CONCLUSION: In our study population, only 13.6% of the cases had an abnormal MCA PI. Further studies are needed to determine whether there is a different prognosis between the two groups.
during the 6-8 month postpartum period. We investigated their breastfeeding conditions at 6-8 weeks and 6 months postpartum using a questionnaire. We defined intensive breastfeeding (IBF) as a condition in which breastfeeding accounted for approximately 80100% of the infant’s nutritional intake. All other breastfeeding conditions were defined as non-intensive breastfeeding (non-IBF). We performed an OGTT at 6-8 weeks and 6-8 months postpartum, at which time we measured both plasma glucose and serum insulin, and investigated the effect of breastfeeding on a homeostasis model of assessment of insulin resistance (HOMA-IR). RESULTS: Eighty-eight women with GDM during their index pregnancy were included. Among these women, we found 79% and 63% were in the IBF group at 6-8 weeks and 6 months postpartum, respectively. The HOMA-IR in the IBF group were lower at 6-8 months postpartum than those in the non-IBF group after adjusting for pre-pregnancy obesity, weight gain during pregnancy, and postpartum weight change (p¼0.0005) (Table). CONCLUSION: Intensive breastfeeding for at least 6 months postpartum has the effect of enhancing insulin sensitivity, which is independent of obesity and postpartum weight change in Japanese women with GDM.
Table 1. Congenital cardiac anomalies and rate of abnormal MCA PI.
18
22%
1
1
100%
743 Cost-effectiveness of continuous glucose monitoring vs self-monitoring of blood glucose in women with pregestational diabetes
1
8
12.5%
Brenda Niu1, Amir Aviram2, Amy Valent1, Aaron B. Caughey1
Hypoplastic Right Heart
0
1
0%
Tetralogy of Fallot
0
1
0%
1 Oregon Health & Science University, Portland, OR, 2Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel
Double Outlet Right Ventricle
Anomaly
Decreased MCA PI Total cases Percentage
Hypoplastic Left Heart
4
Ebstein's Anomaly ASD/VSD
0
4
0%
Transposition of the Great Vessels 0
2
0%
Double Aortic Arch
0
1
0%
Truncus Arteriosus
0
2
0%
Tricuspid Regurgitation
0
1
0%
Tortuous DA
0
3
0%
Dilated Coronary Sinus
0
1
0%
Abnormal Aortic Arch
0
1
0%
Total
6
44
13.6%
742 The effect of intensive breastfeeding at 6-8 months postpartum on insulin resistance in Japanese women with gestational diabetes Ichiro Yasuhi1, Tomoko Soda1, Hiroshi Yamashita1, Atsuko Urakawa1, Mihoko Izumi1, Yasushi Umezaki1, Yukari Kugishima1 1
NHO Nagasaki Medical Center, Omura-City, Japan
OBJECTIVE: Breastfeeding has a protective effect against the future
development of diabetes in women with gestational diabetes (GDM). However, the mechanism underlying this effect is not clear. We investigated insulin sensitivity during the 6-8 month postpartum period in women with GDM. STUDY DESIGN: The study included women with GDM who underwent at least one postpartum 75g oral glucose tolerance test (OGTT)
OBJECTIVE: Pregestational diabetes mellitus complicates approximately 1-2% of pregnancies. While current guidelines recommend self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM) provides real-time measurements of glucose levels and may improve glycemic control. We sought to determine whether it is cost effective to use CGM rather than SMBG in women with pregestational diabetes. STUDY DESIGN: A cost-effectiveness model was built using TreeAge to compare outcomes of SMBG vs CGM. The model was constructed with probabilities, costs, and utilities derived from the literature, and results were extrapolated in a theoretical cohort of 120,000 women, representing the number of women with pregestational diabetes per year. The primary outcome was cost per quality-adjusted life year (QALY) with a cost-effectiveness threshold at $100,000/QALY. Secondary outcomes included preeclampsia, macrosomia, cesarean delivery, intrauterine fetal demise, infant death, brachial plexus injury (BPI), and hyperbilirubinemia. Sensitivity analyses to vary model inputs were used to determine robustness of results. RESULTS: When compared to SMBG in our theoretical cohort, CGM led to 27 fewer cases of permanent BPI and 374 fewer cases of transient BPI at an additional cost of $299,269,200. Thus, our model showed that while CGM is more effective than SMBG, CGM is more expensive with an incremental cost-effectiveness ratio (ICER) of $724,324 per QALY. Given our willingness to pay threshold of $100,000 per QALY, CGM is therefore not cost effective. Our baseline assumption for the cost of CGM was $3,900 per pregnancy, and
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S389