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Is it necessary to screen for gestational diabetes in each successive pregnancy
SPO Abstracts
V o l u m e 176, N u m b e r 1, Part 2 A m J Obstet Gynecol
644
645
GLUCOSE CONTROL IN DIABETIC PREGNANCY AND FETAL CHOLESTEROL HOMEOSTASIS. Y. Loft?x, CR. Parker,JK. Dept. Ob/Gyn, Univ. Alabama at Birmingham, Birmingham, AL. OBJECTIVE: Hyperglycemia is associated with increased cholesterol levels in humans, due to excessive glucosylation of Apo B, which retards receptor-mediated clearance of LDL particles. We investigated whether glycemic control in diabetic pregnancy influences cholesterol (C) levels in the fetus. STUDY DESIGN: We evaluated the relationship between umbilical cord C levels and tasting glucose (FG) levels determined daily in 81 insulinrequiring diabetics and weekly in 69 women with diet controlled glucose intolerance over the last 4 weeks of pregnancy. RESULTS: FG levels were inversely correlated (P < 0.001) to gestational age (CA), regardless of diabetic classification. Umbilical cord C levels were inversely related (P < 0.002) to GA and weight, as occurs in infants of women with uncomplicated pregnancy, but did not vary according to diabetic classification. In term infants (n 101), umbilical cord C levels also were inversely related to maternal FG levels at 4 wks (P - 0.006), and 2 wks (P = 0.006) before delivmT; no significant relation was observed the week of delivery. Inverse, timugh not significant, correlations also were seen between FG and C in pregnancies delivered before 37 wks(n = 49). CONCLUSION: In pregnancies complicated by diabetes and glucose intolerance, high maternal FG levels, especially 2 & 4 wks before delivmT, are associated with relatively decreased umbilical cord C levels. We speculate that hyperglycemia and resultant fetal hyperinsulinemia may downregulate fetal hepatic C synthesis.
646
IS IT NECESSARY T O SCREEN FOR GESTATIONAL DIABETES IN
647
EACH SUCCESSIVE PREGNANCY?. D. Danilenko-Dixon, L Mattson', K. .]ohansenx, ~ VanWinteP, H. LK, P Ogburn. Dept. Ob/Gyn, Mayo Clinic, Rochester, MN. OBJECTIVE: To determine the risk of gestational diabetes (GDM) in subsequent pregnancies based on diabetic screen results in a preceding pregnancy. STUDY DESIGN: 3,607 women screened for gestational diabetes in > two pregnancies (626 with > three pregnancies) between 1 / 1 / 8 6 and 12/31/95 were retrospectively identified. The cohort was 94.4% Caucasian. Mean interval from initial to final screen was 3.1 years, with a standard deviation of 1.9 years and a range of 11 months to 10.0 years. A positive screen was defined as plasma glucose concentration of --> 140 m g / d L one hour after a 50 gm oral glucose load administered in a fasting state. The diagnosis of GDM was based on NDDG criteria. RESULTS: ThirV-three (1.14%) of 2,887 initially screen-negative vs. 78 (10.8%) of 720 initially screen-positive women developed GDM in subsequent pregnancies (p < 0.0001). Both incidences differed significantly from onr population GDM incidence of 3.03% (p < 0.0001). Sixteen of 33 women who subsequently developed GDM had an initial screen value between 130 and 139 mg/dL. Of the remaining 17 (0.59%) who developed GDM aider an initial screen < 130, only 4 (0.14%) had none of the following risk factors: obesity, prior macrosomic infant, non-white race, age ~> 35 years, or --> 5 years since initial screen. CONCLUSIONS: In our population, a diabetic screen result of less than 130 m g / d L is associated with a 5-fbld reduction in risk of GDM in a subsequent pregnancy. A 21-fold reduction is found when traditional risk factors are also absent. Confirmation in other populations is warranted prior to advocating selective GDM screening of multiparous women.
S183
THE EFFECT OF COCAINE O N FETAL HEART RATE TRACING DURING LABOR. H. Brown, f RisingeK, A. Hiett. Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN OBJECTIVE: To determine the characteristics of fetal heart rate tracings during labor in women with recent cocaine use. STUDY DESIGN: Between 11/95 and 2/96, 25 women were identified from the toxicoloD' and delivmT logs as being positive for cocaine during labor. The next delivmy within one week at the same gestational age with a negative toxicoloD, screen was chosen as a control. Twenty one pairs with complete fetal tracings and medical records were available tbr review. Utilizing the Lyons scoring system, each tracing was independently analyzed by a perinatologist blinded to the toxicology' status of the woman. The tracing were graded on the following characteristics: baseline heart rate, short and long term variability, presence of accelerations, and fi-equency, Wpe and severity of decelerations. Primat 7 outcome variables evaluated included Apgar score, birth weight, cord pH, and obstetric complications. Allalysis was by "t" test, X z and Fisher exact test with significance at the 0.05 level. RESULTS: The median Lyons score for cocaine positive women was 7 versus a score of 8 for the controls, p NS. And abnormal score (<8) was noted in 11/21 (52%) tracings in the cocaine group and 8/21 (38%) of the control group. There was no dil~erence in cord pH or 5 minute Apgar for cocaine versus controls. CONCLUSIONS: Although, cocaine exposed fietuses have significant changes in the fetal heart rate tracing during labor, these changes may not be predictive of fetal distress.
THE EFFECT OF SMOKING TOBACCO O N NEONATAL BODY COMPOSITION. C. Lindsay, A. Thomas~, P. Catalano. Dept. of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio. OBJECTIVE: The purpose of this study was to examine the dilterences in body composition in infants of women who smoke during pregnancy(S) compared with the infants of wornen who did not smoke (NS). STUDY DESIGN: Within 24 hours of birth anthropometric measuremerits and total body electrical conductivity (TOBEC) estimates of body composition were obtained on 129 term infants (30 S and 99 NS). Maternal and paternal demographic factors between groups were compared. The anthropometric lneasurenmnts included weight; triceps, subscapular, flank, femur and abdominal skinfolds; and crown-heel, forearm, upper arm, femur, and lower leg lengths. The anthropometric measurements and TOBEC estimation of body composition fi'om S during pregnancy were compared with NS using student's t-test, with the data being expressed as mean + SD. RESULTS: There was a significant decrease in mean birthweight in S vs. NS (3.1 + 0.4 kg vs. 3.4 _+ 0.5, p = 0.05). S had significantly decreased Fat free nrass as estimated by TOBEC (2.8 + 0.3 kg vs. 3.0 -+ 0.4 kg, p = .02), but no significant difference in fat mass (343 _+ 164 gm vs. 387 -+ 216 gm, p - 0.32) when compared with NS. There was a decrease in crown-heel length (49.2 -+ 2.0 cm vs. 50.1 + 2.2 cm, p = 0.03), the length of the fenmr (9.1 + 0.7 cm v. 9.9 +- 0.8 cm, p = .0001), lower leg (7.9 + 0.6 cm v. 8.4 + 0.6 cm, p - .0001) and the forearm (7.2 + 0.5 cm v. 7.5 -+ 0.4 cm, p = .0001) were shorter in S vs. NS. There were no differences in the skinfold and limb circumference lneasurenlents between the two groups. An analysis of covariance performed to adjust for the con%unding demographic factors in the comparison of anthropometric and TOBEC estimation of body composition between the two groups did not change the final results. CONCLUSIONS: The decrease in birthweight in infants of women who smoked during pregnancy is because of a decrease in fat free mass, and not a decrease in adipose tissue. These results may have long term implications for the ei~ect of maternal smoking on fetal and neonatal growth. Supported by General Clinical Research Center RR 7.00080.
V o l u m e 176, N u m b e r 1, Part 2 A m J Obstet Gynecol
644
645
GLUCOSE CONTROL IN DIABETIC PREGNANCY AND FETAL CHOLESTEROL HOMEOSTASIS. Y. Loft?x, CR. Parker,JK. Dept. Ob/Gyn, Univ. Alabama at Birmingham, Birmingham, AL. OBJECTIVE: Hyperglycemia is associated with increased cholesterol levels in humans, due to excessive glucosylation of Apo B, which retards receptor-mediated clearance of LDL particles. We investigated whether glycemic control in diabetic pregnancy influences cholesterol (C) levels in the fetus. STUDY DESIGN: We evaluated the relationship between umbilical cord C levels and tasting glucose (FG) levels determined daily in 81 insulinrequiring diabetics and weekly in 69 women with diet controlled glucose intolerance over the last 4 weeks of pregnancy. RESULTS: FG levels were inversely correlated (P < 0.001) to gestational age (CA), regardless of diabetic classification. Umbilical cord C levels were inversely related (P < 0.002) to GA and weight, as occurs in infants of women with uncomplicated pregnancy, but did not vary according to diabetic classification. In term infants (n 101), umbilical cord C levels also were inversely related to maternal FG levels at 4 wks (P - 0.006), and 2 wks (P = 0.006) before delivmT; no significant relation was observed the week of delivery. Inverse, timugh not significant, correlations also were seen between FG and C in pregnancies delivered before 37 wks(n = 49). CONCLUSION: In pregnancies complicated by diabetes and glucose intolerance, high maternal FG levels, especially 2 & 4 wks before delivmT, are associated with relatively decreased umbilical cord C levels. We speculate that hyperglycemia and resultant fetal hyperinsulinemia may downregulate fetal hepatic C synthesis.
646
IS IT NECESSARY T O SCREEN FOR GESTATIONAL DIABETES IN
647
EACH SUCCESSIVE PREGNANCY?. D. Danilenko-Dixon, L Mattson', K. .]ohansenx, ~ VanWinteP, H. LK, P Ogburn. Dept. Ob/Gyn, Mayo Clinic, Rochester, MN. OBJECTIVE: To determine the risk of gestational diabetes (GDM) in subsequent pregnancies based on diabetic screen results in a preceding pregnancy. STUDY DESIGN: 3,607 women screened for gestational diabetes in > two pregnancies (626 with > three pregnancies) between 1 / 1 / 8 6 and 12/31/95 were retrospectively identified. The cohort was 94.4% Caucasian. Mean interval from initial to final screen was 3.1 years, with a standard deviation of 1.9 years and a range of 11 months to 10.0 years. A positive screen was defined as plasma glucose concentration of --> 140 m g / d L one hour after a 50 gm oral glucose load administered in a fasting state. The diagnosis of GDM was based on NDDG criteria. RESULTS: ThirV-three (1.14%) of 2,887 initially screen-negative vs. 78 (10.8%) of 720 initially screen-positive women developed GDM in subsequent pregnancies (p < 0.0001). Both incidences differed significantly from onr population GDM incidence of 3.03% (p < 0.0001). Sixteen of 33 women who subsequently developed GDM had an initial screen value between 130 and 139 mg/dL. Of the remaining 17 (0.59%) who developed GDM aider an initial screen < 130, only 4 (0.14%) had none of the following risk factors: obesity, prior macrosomic infant, non-white race, age ~> 35 years, or --> 5 years since initial screen. CONCLUSIONS: In our population, a diabetic screen result of less than 130 m g / d L is associated with a 5-fbld reduction in risk of GDM in a subsequent pregnancy. A 21-fold reduction is found when traditional risk factors are also absent. Confirmation in other populations is warranted prior to advocating selective GDM screening of multiparous women.
S183
THE EFFECT OF COCAINE O N FETAL HEART RATE TRACING DURING LABOR. H. Brown, f RisingeK, A. Hiett. Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN OBJECTIVE: To determine the characteristics of fetal heart rate tracings during labor in women with recent cocaine use. STUDY DESIGN: Between 11/95 and 2/96, 25 women were identified from the toxicoloD' and delivmT logs as being positive for cocaine during labor. The next delivmy within one week at the same gestational age with a negative toxicoloD, screen was chosen as a control. Twenty one pairs with complete fetal tracings and medical records were available tbr review. Utilizing the Lyons scoring system, each tracing was independently analyzed by a perinatologist blinded to the toxicology' status of the woman. The tracing were graded on the following characteristics: baseline heart rate, short and long term variability, presence of accelerations, and fi-equency, Wpe and severity of decelerations. Primat 7 outcome variables evaluated included Apgar score, birth weight, cord pH, and obstetric complications. Allalysis was by "t" test, X z and Fisher exact test with significance at the 0.05 level. RESULTS: The median Lyons score for cocaine positive women was 7 versus a score of 8 for the controls, p NS. And abnormal score (<8) was noted in 11/21 (52%) tracings in the cocaine group and 8/21 (38%) of the control group. There was no dil~erence in cord pH or 5 minute Apgar for cocaine versus controls. CONCLUSIONS: Although, cocaine exposed fietuses have significant changes in the fetal heart rate tracing during labor, these changes may not be predictive of fetal distress.
THE EFFECT OF SMOKING TOBACCO O N NEONATAL BODY COMPOSITION. C. Lindsay, A. Thomas~, P. Catalano. Dept. of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio. OBJECTIVE: The purpose of this study was to examine the dilterences in body composition in infants of women who smoke during pregnancy(S) compared with the infants of wornen who did not smoke (NS). STUDY DESIGN: Within 24 hours of birth anthropometric measuremerits and total body electrical conductivity (TOBEC) estimates of body composition were obtained on 129 term infants (30 S and 99 NS). Maternal and paternal demographic factors between groups were compared. The anthropometric lneasurenmnts included weight; triceps, subscapular, flank, femur and abdominal skinfolds; and crown-heel, forearm, upper arm, femur, and lower leg lengths. The anthropometric measurements and TOBEC estimation of body composition fi'om S during pregnancy were compared with NS using student's t-test, with the data being expressed as mean + SD. RESULTS: There was a significant decrease in mean birthweight in S vs. NS (3.1 + 0.4 kg vs. 3.4 _+ 0.5, p = 0.05). S had significantly decreased Fat free nrass as estimated by TOBEC (2.8 + 0.3 kg vs. 3.0 -+ 0.4 kg, p = .02), but no significant difference in fat mass (343 _+ 164 gm vs. 387 -+ 216 gm, p - 0.32) when compared with NS. There was a decrease in crown-heel length (49.2 -+ 2.0 cm vs. 50.1 + 2.2 cm, p = 0.03), the length of the fenmr (9.1 + 0.7 cm v. 9.9 +- 0.8 cm, p = .0001), lower leg (7.9 + 0.6 cm v. 8.4 + 0.6 cm, p - .0001) and the forearm (7.2 + 0.5 cm v. 7.5 -+ 0.4 cm, p = .0001) were shorter in S vs. NS. There were no differences in the skinfold and limb circumference lneasurenlents between the two groups. An analysis of covariance performed to adjust for the con%unding demographic factors in the comparison of anthropometric and TOBEC estimation of body composition between the two groups did not change the final results. CONCLUSIONS: The decrease in birthweight in infants of women who smoked during pregnancy is because of a decrease in fat free mass, and not a decrease in adipose tissue. These results may have long term implications for the ei~ect of maternal smoking on fetal and neonatal growth. Supported by General Clinical Research Center RR 7.00080.