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98 MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITIES IN TWIN-TO-TWINTRANSFUSION SYNDROME FETUSES AROUND THE TIME OF FETOSCOPIC LASERCOAGULATION LÉONARDO GUCCIARDO1, PHILIPP KLARITSCH1, TIM VAN MIEGHEM1,ELISA DONE1, JACQUES JANI1, PAUL LEWI1, LIESBETH LEWI1, JAN DEPREST1, 1UniversityHospitals Leuven, Obstetrics and Gynaecology, Leuven, Belgium

OBJECTIVE: To determine the impact of laser ablation on fetal cerebrovascularblood flow by assessing middle cerebral artery peak systolic velocity (MCA-PSV) inmonochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS).

STUDY DESIGN: We reviewed our database of patients treated for TTTS by lasercoagulation between 2002 and 2007 with available fetal MCA-PSV values. Measureswere transformed to multiples of the median (MoM) based on reference rangesestablished in MC twins. Paired analysis was performed to compare values 24hbefore with 48h after laser. Fetuses with MCA-PSV �1.5 MoM within 48h afterlaser were analyzed separately.

RESULTS: 118 fetuses had measurements both 24h before and 48h after laser.Laser was followed by an increase in MCA-PSV in all fetuses. Of the 109 ex-recip-ients and 105 ex-donors with available measurements 48h after laser, 27 (12.6%)had MCA-PSV �1.5 MoM. Ex-recipients (20;18.3%) had more often MCA-PSV�1.5Mom than ex-donors (7; 6.7%). 16/20 (80%) ex-recipients and 6/7(85.7%) ex-donors with MCA-PSV �1.5 MoM subsequently survived, comparedto 90/98 (91.8%) and 89/90 (98.9%) with normal values 48h after laser (not signif-icantly different). When both survived 40% (7/18) of ex-recipients but no ex-do-nors with elevated MCA-PSV had a co-twin with MCA-PSV �0.8 MoM, consistentwith a twin-anemia-polycythemia-sequence (TAPS). One of these had an intra-uterine transfusion, another one opted for selective feticide and the others resolvedspontaneously within the next weeks.

CONCLUSION: There was an overall increase in MCA-PSV 48h after laser ther-apy. MCA-PSV�1.5 MoM was observed in 13% of fetuses but more frequently inex-recipients. Overall, outcome of fetuses with elevated PSV shortly after laser isfavorable. In 40% of these TAPS was diagnosed which also resolved spontaneouslyin the majority of cases.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.729

99 IMPACT OF 17-ALPHA-HYDROXYPROGESTERONE CAPROATE ON GLUCOSEINTOLERANCE IN PREGNANCY THADDEUS WATERS1, BRETT SCHULTZ1, BRIANMERCER1, PATRICK CATALANO1, 1MetroHealth Medical Center - Case Western Re-serve University, Department of Ob/Gyn, Cleveland, Ohio

OBJECTIVE: To determine if 17-alpha-OH-progesterone caproate (17OHPC)treatment in pregnancy increases the frequency of abnormal glucose screening andgestational diabetes (GDM).

STUDY DESIGN: This is a retrospective cohort study of women treated withweekly 17OHPC because of a prior singleton preterm birth. Women with pre-gestational diabetes and multiple gestations were excluded. 17OHPC exposed sub-jects were matched to 3 unexposed controls by maternal age and pre-pregnancybody mass index (BMI). The primary outcomes were abnormal 1 hour glucosescreen and GDM.

RESULTS: Individual chart review was performed on 440 women (11017OHPC matched to 330 controls). Maternal characteristics between 17OHPC andcontrols were similar including age (29 vs 29 yrs, p�0.77), pre-pregnancy BMI (27vs 27 kg/m2, p�0.99) and race (46 vs 39% African-American, 17 vs 18% Hispanic,36 vs 40% Caucasian, p�0.57). Abnormal 1 hour glucose screens were more fre-quent in the 17OHPC group (26.6 vs 11.2%, p�0.001) and mean 1 hour glucosevalues were increased in the 17OHPC group (p�0.01) regardless of maternal BMI(figure). GDM was more frequent in the 17OHPC group (10.9 vs. 3.6%, p�0.004).17OHPC remained independently associated with the diagnosis of GDM (OR: 3.3;1.42-7.67, p�0.005) in a logistic regression analysis controlling for maternal BMI,age, and race.

CONCLUSION: Women receiving weekly intramuscular 17OHPC have morefrequent abnormal glucose testing and gestational diabetes compared with unex-posed controls. These results are consistent with published data regarding the im-pact of progesterone on insulin resistance.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.730

200 American Journal of Obstetrics & Gynecology Supplement to DECEMBER

00 A COMPARISON OF GLYBURIDE/METFORMIN AND INSULIN FOR GESTATIONALDIABETES AMANDA HUTCHINSON1, CLARISA HAUGABROOK2, LINDA LONG2, LORRIEMASON2, JOSEPH KIPIKASA3, DAVID ADAIR4, 1University of Tennessee Health ScienceCenter, Chattanooga, Tennessee, 2University of Tennessee Health Science Center,Tennessee, 3University of Tennessee College of Medicine, Chattanooga Unit, Ma-ternal Fetal Medicine, Chattanooga, Tennessee, 4University of Tennessee College ofMedicine, Chattanooga, Tennessee

OBJECTIVE: The objective of this study is to compare glycemic control withglyburide/metformin, an oral hypoglycemic, to injected insulin in type 2 and ges-tational diabetic pregnancies requiring medication.

STUDY DESIGN: We recruited patients seen in consultation with our perina-tologists for gestational diabetes or type 2 diabetes not previously requiring insulin.Subjects were assigned either an insulin (control) or glyburide/metformin (study)regimen. Subjects monitored their glucose levels at home and reported weekly.Medication changes were made by the perinatologist for optimal glucose control. Inaddition to routine obstetrical care, patients were seen twice weekly after 28 weeks.At delivery, umbilical cord glucose, hemoglobin A1C, fructosamine, and infant 1hour glucose levels were collected to assess long and short-term glycemic control.

RESULTS: Variables compared included gestational age at delivery, birthweight, umbilical cord glucose, fructosamine, and glycosylated hemoglobin, neo-natal 1-hour glucose, NICU admissions, and infant length of stay.

We enrolled 172 patients with 80 in the insulin arm and 92 in the glyburide/metformin arm. Statistical analyses of the data using the Chi-squared and t-testsrevealed no significant differences at p�0.05 between the two groups. Mean gesta-tional age at delivery was 37.2 and 37.3 weeks in the control and study groupsrespectively. Mean birth weights were 3105.6 (control) and 3289.9 grams (study).The mean HA1C was 3.93% (control) and 3.4% (study). Mean fructosamine was169.22 umol/L (control) and 162.51 umol/L (study). Mean glucose was 68.01 mg/dl(control) and 71.72 mg/dl (study). The 1 hour neonatal glucose means were 62.43mg/dl (control) and 53.43 mg/dl (study). NICU admissions, NICU admissions forhypoglycemia, and infant lengths of stay were not significantly different.

CONCLUSION: Glyburide/metformin is an effective agent in the management ofgestational diabetes and type 2 diabetics in pregnancy.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.731

01 SERUM CONCENTRATION OF PLACENTAL PROTEIN 13 (PP13) IN PREGNANT WOMEN ISINFLUENCED BY MATERNAL BLOOD GROUP NANDOR GABOR THAN1, RONACKERMAN2, ILANA CHEFETZ2, YAEL-INNA GRIMPLE2, MAREI SAMMAR2, TAL OTIKER3,HAMUTAL MEIRI2, RON GONEN4, 1Semmelweis University, Budapest, Hungary, 2Diag-nostic Technologies, Yokneam, Israel, 3TechnoSTAT, Ra’anana, Israel, 4Depart-ment of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medi-cine, Technion - Israel Institute of Technology, Haifa, Israel

OBJECTIVE: Placental Protein 13 (PP13) is a galectin, which binds beta-galac-tosides. In previous studies, maternal serum PP13 multiple of the medians (MoM)adjusted to gestational age (GA), body mass index, maternal age, ethnicity, andparity was found to predict preeclampsia with sensitivity of 85% at 20% false pos-itive rate (FPR) based on first trimester MoM. For the same sensitivity, FPR reducedto 6% when the slope between PP13 concentrations during the first and secondtrimesters were sequentially evaluated with first trimester PP13 MoM. The objec-tive of this study was to examine maternal serum PP13 MoMs in the first and secondtrimesters of pregnancy in relation to maternal ABO and Rhesus (Rh) blood groups.

STUDY DESIGN: Sequential blood samples were obtained from 1366 womenwith singelton viable pregnancies at 6-10, 16-20 and 24-28 weeks. PP13 concentra-tions were measured by ELISA. ABO and Rh blood groups were determined by astandard tile technique. ABO and Rh blood groups were added as additional con-founders to the PP13 MoM algorithm. P�0.05 was considered significant.

RESULTS: The prevalence of blood groups in the cohort was 46% O, 43% A, 8%B and 3% AB. Rh negative women were 6%. Median PP13 MoMs were higher inwomen with blood group B than in women with other blood groups in all threecomparisons [at GA 6-10: B�1.26, AB�0.93(P�0.01), O�1.07, A�0.78; at GA16-20: B�1.84, AB�0.94(P�0.01), O�1.05, A�0.88; and at GA 24-28: B�1.32,AB�0.72(P�0.01), O�1.12(P�0.05), A�0.87]. The Rh factor had no effect onPP13 MoMs at any of the time periods examined.

CONCLUSION: The results are consistent with the high-affinity of PP13 to N-acetyl-galactosamine present on group A antigen and its lower affinity to galactosepresent on group B antigen. Our results suggest that maternal blood group shouldbe considered as another important confounder in adjustment of PP13 MoMs thatmay improve preeclampsia prediction.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2008.09.732

2008