- Email: [email protected]
W166 RESPONSE OF THERAPY WITH VITAMIN B6, B12 AND FOLIC ACID ON HOMOCYSTEINE LEVEL AND PREGNANCY OUTCOME IN HYPERHOMOCYSTEINEMIA WITH UNEXPLAINED RECURRENT ABORTIONS
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Materials and Methods: Between Jan 1st 2006 and Dec 31st, 2006, one hundred out of 4558 admissions to labor ward at El Minya Maternity University Hospital complicated with primary atonic PPH. Blood samples for Hb, and PN measurements were obtained on diagnosis, before regular PPH management was applied and at the end of third stage of labor for controls. Comparisons of clinical outcome; Hb; and PN between treatment responders and non-responders were undertaken. Results: Hemoglobin levels of all women with atonic PPH was <9 g/dl and it was <7.2 g/dl in the 25 non-responders (P < 0.001). PN levels were 76.6±13.65 mM/mL Vs 63.9±15 mM/mL for women with atonic PPH and controls (P < 0.01). Furthermore, PN levels were significantly higher in non-responders than responders (92.3±12.3 mM/mL vs. 60.9±15 mM/m (P < 0.001). Frequent severer complications reported in non-responders, among whom were 3 deaths (P < 0.001). Conclusions: Preventing or treating severe anemia before labor may improve treatment response to CM and reduces complications due to NO cytotoxicity to the uterus and other organs W166 RESPONSE OF THERAPY WITH VITAMIN B6, B12 AND FOLIC ACID ON HOMOCYSTEINE LEVEL AND PREGNANCY OUTCOME IN HYPERHOMOCYSTEINEMIA WITH UNEXPLAINED RECURRENT ABORTIONS N. Agarwal1 , S. Dora1 , A. Kriplani1 , P. Garg1 , S. Vivekanandhan2 , V. Kulshrestha1 . 1 Obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India; 2 All India Institute of Medical Sciences, New Delhi, Delhi, India Objectives: To assess response of therapy with Vitamin B6, B12 and folic acid on levels of homocysteine and pregnancy outcome in relation to therapy in cases of unexplained recurrent abortions. Materials: Total 50 cases of recurrent abortions (≥2) were recruited and randomized to groups I and Group II with 25 cases in each group. Methods: Baseline homocysteine levels were measured in all cases. Therapy was started with Vitamin B12 1500 mcg, Vitamin B6 10 mg and folic acid 5 mg daily: throughout pregnancy in Group I and for 12 weeks in group II. Homocysteine levels were reassessed after therapy. Pregnancy outcomes like abortion, pre-eclampsia, IUGR, preterm labour were assessed. Results: Mean baseline homocysteine was 11.9±3.5 & 13.2±5.5 mmol/L which decreased to 7.4±2.4 (by 37.8%) and 8.5±2.3 (by 35.5%) after therapy in group I & II respectively. Hyperhomocysteinemia (>15 mmol/L) was found in 15 cases – 6 in group I and 9 in group II with mean homocysteine being 17.5±1.4 and 19.0±5.0 respectively; fall occurred to 9.8±2.2 (by 43.9%) & 10.4±1.2 (44.8%) mmol/L. In rest 35 cases (19 in group I & 16 in group II) homocysteine levels were normal: 8.1±1.4 & 8.3±2.1 mmol/L, which reduced to 6.6±1.9 (by 18.5%) and 6.4±2.1 (by22.4%) mmol/L in group I & II respectively. Abortion rate with hyperhomocysteinemia was 4/15 (26.6%) versus 4/35 (11.4%) in patients with normal homocysteine. In group I all abortions occurred in 1st trimester whereas in group II, 2 cases had 2nd trimester abortion. Baseline homocysteine levels were 16.4±3.4 & 12.1±3.8 mmol/L in abortion cases and 6.4±2.4 & 6.5±2.3 mmol/L in other cases who delivered normally in group I & II respectively. IUGR developed in 2 (8%) in group I and 5 (20%) in group II. Out of these 7 cases of IUGR, 1/15 (6.6%) occurred in hyperhomocysteineimic patients and 6/35 (17.1%) in normal homocysteine cases. Mean homocystiene levels were 9.8±5 in IUGR cases and 11.2±4.4 in normal cases. No correlation of preterm delivery and preelampsia were found to homocystein levels or duration of therapy. Conclusions: Fall of homocysteine is more in hyperhomocysteinemic cases after therapy. There is 2.5 fold increased risk of abortion in hyperhomocysteinemia. Long term therapy prevents late abortions and also reduces risk of IUGR, but there is no correlation to homocysteine levels.
S759
W167 CHARACTERISTICS OF PREGNANT WOMEN WITH ONE ABNORMAL VALUE ON 75-G ORAL GLUCOSE TOLERANCE TEST Y. Kozuma1 , T. Horinouchi1 , T. Shimomura1 , T. Kawata1 , R. Hayashi1 , D. Hori1 , T. Kamura1 . 1 Kurume University, Kurume city, Japan Objectives: The aim of this study was to define the factors predicting the need for insulin therapy in pregnant women with one abnormal value (OAV) during 75-g oral glucose tolerance test (75-g OGTT). Materials: A total of 118 pregnant women with OAV between 1997 and 2010 were studied. We analyzed between pregnant women with OAV those who required insulin therapy for glycemic control (insulin group; n = 17) and who did not (diet group; n = 101). Methods: The following factors were analyzed; maternal age, family history of diabetes, prepregnancy BMI, HbA1c, each value of plasma glucose (PG) and immunoreactive insulin (IRI) on 75-g OGTT (fasting, 0.5, 1 and 2-h), insulinogenic index (I.I), HOMA-IR, and ISI composite. Results: Univariable analysis showed a positive correlation between insulin therapy and PG 2-h value, IRI 0.5-h and 1-h value, insulinogenic index, and HbA1c (p < 0.05). Multivariate analysis showed that PG 2-h value and I.I were predictors for insulin need. The PG 2-h cut-off value of 179 mg/dl (sensitivity 47%, 1-specificity 45%) was evaluated on ROC curve for the prediction. Conclusions: These results suggest that the group of PG 2-h value ≥180 mg/dl on 75-g OGTT may be regarded as high risk GDM. W168 MATERNAL SERUM PROTEIN S ACTIVITY IN PREGNANCIES ASSOCIATED WITH INTRAUTERINE FETAL GROWTH RESTRICTION J.I. Kim1 , J.C. Park1 . 1 Obstetrics and Gynecology, Dongsan Hospital, School of Medicine, Keimyung University, Daegu, Korea, Republic of Objectives: Protein S is a cofactor of protein C which lowers the activated factors VIII and V. Pregnancy reduces the levels of protein S to 40–50% of normal levels, but the clinical relevance of protein S deficiency in pregnant women remains controversial. In order to define protein S deficiency, total protein S with free and functional protein should be evaluated. The aim of this study was to determine any parameters between decreased Protein S activity and intrauterine fetal growth restriction (IUGR). Materials and Methods: A retrospective case-control study of women with IUGR (n = 35) and healthy control (n = 90) in the third trimester of pregnancy. Results: Maternal serum protein S values of women in the IUGR group were significantly lower levels of free and functional protein S compared with the control group: 43.25±12.2% vs 58.45±13.27% (p < 0.003) and 48.07±18.72% vs 67.20±15.59% (P < 0.005), respectively. No significant correlation was found between total protein S and IUGR. Conclusions: Excessive decreases in protein S activity during the third trimester of pregnancy could contribute to development of intrauterine fetal growth restriction. Specially, levels of functional and free protein S are correlated with intrauterine fetal growth restriction. W169 PREGNANCY OUTCOME AFTER CERVICAL CONIZATION: RISK FACTORS FOR PRETERM DELIVERY T. Tsuburai1 , K. Kurasawa1 , M. Okuda1 , T. Takahashi1 , H. Yoshida2 , F. Hirahara3 . 1 Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan; 2 Gynecology, Yokohama City University Medical Center, Yokohama, Japan; 3 Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan Objectives: The number of young women undergoing cervical conization for the treatment of cervical dysplasia and intraepithelial
Materials and Methods: Between Jan 1st 2006 and Dec 31st, 2006, one hundred out of 4558 admissions to labor ward at El Minya Maternity University Hospital complicated with primary atonic PPH. Blood samples for Hb, and PN measurements were obtained on diagnosis, before regular PPH management was applied and at the end of third stage of labor for controls. Comparisons of clinical outcome; Hb; and PN between treatment responders and non-responders were undertaken. Results: Hemoglobin levels of all women with atonic PPH was <9 g/dl and it was <7.2 g/dl in the 25 non-responders (P < 0.001). PN levels were 76.6±13.65 mM/mL Vs 63.9±15 mM/mL for women with atonic PPH and controls (P < 0.01). Furthermore, PN levels were significantly higher in non-responders than responders (92.3±12.3 mM/mL vs. 60.9±15 mM/m (P < 0.001). Frequent severer complications reported in non-responders, among whom were 3 deaths (P < 0.001). Conclusions: Preventing or treating severe anemia before labor may improve treatment response to CM and reduces complications due to NO cytotoxicity to the uterus and other organs W166 RESPONSE OF THERAPY WITH VITAMIN B6, B12 AND FOLIC ACID ON HOMOCYSTEINE LEVEL AND PREGNANCY OUTCOME IN HYPERHOMOCYSTEINEMIA WITH UNEXPLAINED RECURRENT ABORTIONS N. Agarwal1 , S. Dora1 , A. Kriplani1 , P. Garg1 , S. Vivekanandhan2 , V. Kulshrestha1 . 1 Obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India; 2 All India Institute of Medical Sciences, New Delhi, Delhi, India Objectives: To assess response of therapy with Vitamin B6, B12 and folic acid on levels of homocysteine and pregnancy outcome in relation to therapy in cases of unexplained recurrent abortions. Materials: Total 50 cases of recurrent abortions (≥2) were recruited and randomized to groups I and Group II with 25 cases in each group. Methods: Baseline homocysteine levels were measured in all cases. Therapy was started with Vitamin B12 1500 mcg, Vitamin B6 10 mg and folic acid 5 mg daily: throughout pregnancy in Group I and for 12 weeks in group II. Homocysteine levels were reassessed after therapy. Pregnancy outcomes like abortion, pre-eclampsia, IUGR, preterm labour were assessed. Results: Mean baseline homocysteine was 11.9±3.5 & 13.2±5.5 mmol/L which decreased to 7.4±2.4 (by 37.8%) and 8.5±2.3 (by 35.5%) after therapy in group I & II respectively. Hyperhomocysteinemia (>15 mmol/L) was found in 15 cases – 6 in group I and 9 in group II with mean homocysteine being 17.5±1.4 and 19.0±5.0 respectively; fall occurred to 9.8±2.2 (by 43.9%) & 10.4±1.2 (44.8%) mmol/L. In rest 35 cases (19 in group I & 16 in group II) homocysteine levels were normal: 8.1±1.4 & 8.3±2.1 mmol/L, which reduced to 6.6±1.9 (by 18.5%) and 6.4±2.1 (by22.4%) mmol/L in group I & II respectively. Abortion rate with hyperhomocysteinemia was 4/15 (26.6%) versus 4/35 (11.4%) in patients with normal homocysteine. In group I all abortions occurred in 1st trimester whereas in group II, 2 cases had 2nd trimester abortion. Baseline homocysteine levels were 16.4±3.4 & 12.1±3.8 mmol/L in abortion cases and 6.4±2.4 & 6.5±2.3 mmol/L in other cases who delivered normally in group I & II respectively. IUGR developed in 2 (8%) in group I and 5 (20%) in group II. Out of these 7 cases of IUGR, 1/15 (6.6%) occurred in hyperhomocysteineimic patients and 6/35 (17.1%) in normal homocysteine cases. Mean homocystiene levels were 9.8±5 in IUGR cases and 11.2±4.4 in normal cases. No correlation of preterm delivery and preelampsia were found to homocystein levels or duration of therapy. Conclusions: Fall of homocysteine is more in hyperhomocysteinemic cases after therapy. There is 2.5 fold increased risk of abortion in hyperhomocysteinemia. Long term therapy prevents late abortions and also reduces risk of IUGR, but there is no correlation to homocysteine levels.
S759
W167 CHARACTERISTICS OF PREGNANT WOMEN WITH ONE ABNORMAL VALUE ON 75-G ORAL GLUCOSE TOLERANCE TEST Y. Kozuma1 , T. Horinouchi1 , T. Shimomura1 , T. Kawata1 , R. Hayashi1 , D. Hori1 , T. Kamura1 . 1 Kurume University, Kurume city, Japan Objectives: The aim of this study was to define the factors predicting the need for insulin therapy in pregnant women with one abnormal value (OAV) during 75-g oral glucose tolerance test (75-g OGTT). Materials: A total of 118 pregnant women with OAV between 1997 and 2010 were studied. We analyzed between pregnant women with OAV those who required insulin therapy for glycemic control (insulin group; n = 17) and who did not (diet group; n = 101). Methods: The following factors were analyzed; maternal age, family history of diabetes, prepregnancy BMI, HbA1c, each value of plasma glucose (PG) and immunoreactive insulin (IRI) on 75-g OGTT (fasting, 0.5, 1 and 2-h), insulinogenic index (I.I), HOMA-IR, and ISI composite. Results: Univariable analysis showed a positive correlation between insulin therapy and PG 2-h value, IRI 0.5-h and 1-h value, insulinogenic index, and HbA1c (p < 0.05). Multivariate analysis showed that PG 2-h value and I.I were predictors for insulin need. The PG 2-h cut-off value of 179 mg/dl (sensitivity 47%, 1-specificity 45%) was evaluated on ROC curve for the prediction. Conclusions: These results suggest that the group of PG 2-h value ≥180 mg/dl on 75-g OGTT may be regarded as high risk GDM. W168 MATERNAL SERUM PROTEIN S ACTIVITY IN PREGNANCIES ASSOCIATED WITH INTRAUTERINE FETAL GROWTH RESTRICTION J.I. Kim1 , J.C. Park1 . 1 Obstetrics and Gynecology, Dongsan Hospital, School of Medicine, Keimyung University, Daegu, Korea, Republic of Objectives: Protein S is a cofactor of protein C which lowers the activated factors VIII and V. Pregnancy reduces the levels of protein S to 40–50% of normal levels, but the clinical relevance of protein S deficiency in pregnant women remains controversial. In order to define protein S deficiency, total protein S with free and functional protein should be evaluated. The aim of this study was to determine any parameters between decreased Protein S activity and intrauterine fetal growth restriction (IUGR). Materials and Methods: A retrospective case-control study of women with IUGR (n = 35) and healthy control (n = 90) in the third trimester of pregnancy. Results: Maternal serum protein S values of women in the IUGR group were significantly lower levels of free and functional protein S compared with the control group: 43.25±12.2% vs 58.45±13.27% (p < 0.003) and 48.07±18.72% vs 67.20±15.59% (P < 0.005), respectively. No significant correlation was found between total protein S and IUGR. Conclusions: Excessive decreases in protein S activity during the third trimester of pregnancy could contribute to development of intrauterine fetal growth restriction. Specially, levels of functional and free protein S are correlated with intrauterine fetal growth restriction. W169 PREGNANCY OUTCOME AFTER CERVICAL CONIZATION: RISK FACTORS FOR PRETERM DELIVERY T. Tsuburai1 , K. Kurasawa1 , M. Okuda1 , T. Takahashi1 , H. Yoshida2 , F. Hirahara3 . 1 Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan; 2 Gynecology, Yokohama City University Medical Center, Yokohama, Japan; 3 Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan Objectives: The number of young women undergoing cervical conization for the treatment of cervical dysplasia and intraepithelial