114 Pregnancy Loss and Thrombosis with Protein C Deficiency in Pregnancy
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Volume Ifi6 :\umber I, Part 2 113 Ic;ITlAL REQCIRED I:iSULI;\ DOSE 11\ GESTATlO:-;AL DIABETICS, J Binderman x , JG Pastorek II, JM Miller Jr, LSU Medical Center, :iew Orleans, L\, Initiating insulin therapy in newly diag- nosed gestational diabetics has traditionally been based on formulas using ideal body weight (IBW), correcting for trimester of gestation, We evaluated formulas using both IBW and actual body weight (ABW) to predict the actual amount of insulin (ACTll\S) required for glucose con- trol, Charts of 37 insulin-requiring gesta- tional diabetics of a 2 year period were re- viewed, tested were Ins =,7(ABW), F2: Ins =a(ABW), F3 =a(LBW) (a = ,6 in 1st tri- mester, ,7 in 2nd, ,8 in 3rd), The ABW insulin dose formulas predicted actual dose required, for F2 the mean difference ±SE was -,S±3.5, and for FI the difference was -4,6±3.S, both not different from zero. The IBW formula differed from actual requirements by -30.5±3.5 (p=.OOI). Stepwise regression of IBW, ABW, and trimester reaffirmed the value of ABW: Ins = 23,3 + .SABW (r=.455, p=,005). Using ABW will better predict the actual insulin needed, thus decreasing the time and cost spent in attaining close glucose control. 114 PREGNANCY LOSS AND THROMBOSIS WITH PROTEIN C DEFICIENCY IN PREGNANCY J Trauscht-Van Hom', E Capeless, EG, Bovill', TR Easterling, B Hermanson" Univ of Washington, Seattle & Univ of Vermont College of Medicine Protein C, a vitamin K dependent plasma protein, inhibits coagulation and promotes fibrinol ysis. The deficiency, inherited in an autosomal dominant pattern, increases the risk of venous thrombosis, This study investigates pregnancy loss and thrombotic disease during pregnancy in protein C deficient women. Materials and Methods: A single New England kindred of 15 protein C deficient cases and 37 related non-deficient controls was studied An obstetrical history was obtained by phone from all women of child bearing age, Data were analyzed by t test and logistic regression analysis, Results: Cases (15) Pregnancy loss(es) 5 (33%) <12 wks 3 >12 wks 2 Premature births «2kg) 0 Mean birth weight 3I68g Birth weight range 2040-4184g Thrombosis in pregnancy 5 (33%) without anticoagulation 5 (45%) Controls (37) 7(19%) 4 3 o 3156g 21524198g 2(5%) Successful pregnancy 15 (100%) 37 (100%) The odds ratio for thrombosis in pregnancy associated with protein C deficiency was 7.37, (P=.026). Conclusions: Protein C deficiency is not associated with increased pregnancy loss and is associated with an increased risk of thrombosis in pregnancy. 115 SPO Abstracts 311 PREDIGnNG THE NECESSITY FOR INSUUN THERAPY IN THE GESTATIONAL DIABETIC. G.L. Goyert. YAH. Daoud,'D.J. Wright,'DB Schwartz. Dept. Ob/Gyn. Div. MFM. Sinai Hospital. Wayne State University School of Medicine. Detroit. MI. A minority of gestational diabetics require insulin therapy to maintain fasting glucose < 100 mg/dl and two hour post-prandial glucose < 120 mg/dl. This study was undertaken to model 3-hour oral GTI results to predict the necessity for insulin therapy. Three hour GTI results of 317 patients referred for management of gestational diabetes between 1988-91 were analyzed via step-wise logistic regression. Independent variables entered into the analysis included the four values of the 3 hour GTI individually. the difference between each post-ingestion value and the fasting value. and the mean of the values obtained following ingestion of the glucola. Sixty nine patients required insulin therapy. The average of the three post-ingestion values (improvement /=59.3) and the fasting value oq. (improvement /=11.7) 'ol/(I+e.p(8J-.CJA'g-.02'",t)) were the two most , significant predictors for 2, 0.7 necessity of insulin z 0 6 therapy. These data facilitate counselling the gestational diabetic and may influence the timing of insulin therapy initiation. especially "prophylactic" insulin regimens. x x x x < ' iiO 116 IMPROVED PERlNATAL OUTCOME AFTER ENHANCED PRENATAL CARE FOR OPIATE ADDICfS. G Chang', KM Carroll'. HM Behr', NJ DeGennaro', TR Kosten', RS Schottcnfeld', and RR Viscarello. Chemical dependency during pregnancy is frequently correlated with poor prenatal care and adverse perinatal outcomes. Nearly 75% of the estimated 300,000 female narcotic addicts in the United States are of childbearing age. Pregnant opiate addicts have a six-fold increase in maternal complications including IUGR, premature labor, third- trimester bleeding, and malpresentation. Newborn complications include neonatal withdrawal syndrome, failure-to-thrive, SIDS, and neurobehavioral problems. In order to improve perinatal outcome for opiate-addicted women. we developed an enhanced program which combines on-site prenatal care, methadone maintenance, supervised childcare. and relapse-prevention strategies. As part of our pilot phase, 12 of 23 pregnant women currently on methadone maintenance agreed to participate in the enhanced program. The 11 patients who declined were followed in a traditional prenatal care setting Both groups had similar demographics including age, years of education, marital status, racial breakdown, parity, and daily methadone dose. Six of the patients in the enhanced group have delivered, 3 elected TOP, and 3 remain undelivered; while in the routine group, 6 have delivered, 1 miscarried, 2 underwent TOP, and 2 are lost to follow-up. Despite a greater mean number of urine toxicology screens (43 vs. 15), subjects in the enhanced program demonstrated a lower percentage of positive results (59% vs. 76%). The enhanced group had significantly more prenatal visits (8.8 vs, 2,7), longer gestations (38.2 wks vs, 35.7 wks), and larger infants (2943g vs. 2280g). Preliminary results suggest improved outcomes in opiate-dependent patients receiving enhanced as compared to routine prenatal care. Such a therapeutic approach also provides the addicted woman with the structural framework to organize her own life and thereby improves parenting- skills.
Transcript of 114 Pregnancy Loss and Thrombosis with Protein C Deficiency in Pregnancy
Volume Ifi6 :\umber I, Part 2
113 Ic;ITlAL REQCIRED I:iSULI;\ DOSE 11\ GESTATlO:-;AL DIABETICS, J Binderman
x, JG Pastorek II,
JM Miller Jr, LSU Medical Center, :iew Orleans, L\,
Initiating insulin therapy in newly diagnosed gestational diabetics has traditionally been based on formulas using ideal body weight (IBW), correcting for trimester of gestation, We evaluated formulas using both IBW and actual body weight (ABW) to predict the actual amount of insulin (ACTll\S) required for glucose control, Charts of 37 insulin-requiring gestational diabetics of a 2 year period were reviewed, ~ormulas tested were ~I: Ins =,7(ABW), F2: Ins =a(ABW), F3 =a(LBW) (a = ,6 in 1st trimester, ,7 in 2nd, ,8 in 3rd), The ABW insulin dose formulas predicted actual dose required, for F2 the mean difference ±SE was -,S±3.5, and for FI the difference was -4,6±3.S, both not different from zero. The IBW formula differed from actual requirements by -30.5±3.5 (p=.OOI). Stepwise regression of IBW, ABW, and trimester reaffirmed the value of ABW: Ins = 23,3 + .SABW (r=.455, p=,005). Using ABW will better predict the actual insulin needed, thus decreasing the time and cost spent in attaining close glucose control.
114 PREGNANCY LOSS AND THROMBOSIS WITH PROTEIN C DEFICIENCY IN PREGNANCY J Trauscht-Van Hom', E Capeless, EG, Bovill', TR Easterling, B Hermanson" Univ of Washington, Seattle & Univ of Vermont College of Medicine
Protein C, a vitamin K dependent plasma protein, inhibits coagulation and promotes fibrinol ysis. The deficiency, inherited in an autosomal dominant pattern, increases the risk of venous thrombosis, This study investigates pregnancy loss and thrombotic disease during pregnancy in protein C deficient women. Materials and Methods: A single New England kindred of 15 protein C deficient cases and 37 related non-deficient controls was studied An obstetrical history was obtained by phone from all women of child bearing age, Data were analyzed by t test and logistic regression analysis, Results:
Cases (15)
Pregnancy loss(es) 5 (33%) <12 wks 3 >12 wks 2
Premature births «2kg) 0 Mean birth weight 3I68g Birth weight range 2040-4184g Thrombosis in pregnancy 5 (33%)
without anticoagulation 5 (45%)
Controls (37) 7(19%)
4 3 o
3156g 21524198g
2(5%)
Successful pregnancy 15 (100%) 37 (100%) The odds ratio for thrombosis in pregnancy associated with protein C deficiency was 7.37, (P=.026). Conclusions: Protein C deficiency is not associated with increased pregnancy loss and is associated with an increased risk of thrombosis in pregnancy.
115
SPO Abstracts 311
PREDIGnNG THE NECESSITY FOR INSUUN THERAPY IN THE GESTATIONAL DIABETIC. G.L. Goyert. YAH. Daoud,'D.J. Wright,'DB Schwartz. Dept. Ob/Gyn. Div. MFM. Sinai Hospital. Wayne State University School of Medicine. Detroit. MI.
A minority of gestational diabetics require insulin therapy to maintain fasting glucose < 100 mg/dl and two hour post-prandial glucose < 120 mg/dl. This study was undertaken to model 3-hour oral GTI results to predict the necessity for insulin therapy. Three hour GTI results of 317 patients referred for management of gestational diabetes between 1988-91 were analyzed via step-wise logistic regression. Independent variables entered into the analysis included the four values of the 3 hour GTI individually. the difference between each post-ingestion value and the fasting value. and the mean of the values obtained following ingestion of the glucola. Sixty nine patients required insulin therapy. The average of the three post-ingestion values (improvement /=59.3) and the fasting value oq.
(improvement /=11.7) ~08: 'ol/(I+e.p(8J-.CJA'g-.02'",t)) were the two most , significant predictors for 2, 0.7
necessity of insulin z 0 6
therapy. These data facilitate counselling the gestational diabetic and may influence the timing of insulin therapy initiation. especially "prophylactic" insulin regimens.
x x
x x < '
iiO
116 IMPROVED PERlNAT AL OUTCOME AFTER ENHANCED PRENATAL CARE FOR OPIATE ADDICfS. G Chang', KM Carroll'. HM Behr', NJ DeGennaro', TR Kosten', RS Schottcnfeld', and RR Viscarello.
Chemical dependency during pregnancy is frequently correlated with poor prenatal care and adverse perinatal outcomes. Nearly 75% of the estimated 300,000 female narcotic addicts in the United States are of childbearing age. Pregnant opiate addicts have a six-fold increase in maternal complications including IUGR, premature labor, thirdtrimester bleeding, and malpresentation. Newborn complications include neonatal withdrawal syndrome, failure-to-thrive, SIDS, and neurobehavioral problems. In order to improve perinatal outcome for opiate-addicted women. we developed an enhanced program which combines on-site prenatal care, methadone maintenance, supervised childcare. and relapse-prevention strategies. As part of our pilot phase, 12 of 23 pregnant women currently on methadone maintenance agreed to participate in the enhanced program. The 11 patients who declined were followed in a traditional prenatal care setting Both groups had similar demographics including age, years of education, marital status, racial breakdown, parity, and daily methadone dose. Six of the patients in the enhanced group have delivered, 3 elected TOP, and 3 remain undelivered; while in the routine group, 6 have delivered, 1 miscarried, 2 underwent TOP, and 2 are lost to follow-up. Despite a greater mean number of urine toxicology screens (43 vs. 15), subjects in the enhanced program demonstrated a lower percentage of positive results (59% vs. 76%). The enhanced group had significantly more prenatal visits (8.8 vs, 2,7), longer gestations (38.2 wks vs, 35.7 wks), and larger infants (2943g vs. 2280g). Preliminary results suggest improved outcomes in opiate-dependent patients receiving enhanced as compared to routine prenatal care. Such a therapeutic approach also provides the addicted woman with the structural framework to organize her own life and thereby improves parentingskills.
