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ELEVATED MATERNAL BODY MASS INDEX IS INDEPENDENT RISK FAC- TOR TO DEVELOP PREECLAMPSIA IDIT EREZ MD l, OFFER EREZ MD 2, ILLANA SHOHAM~VARDI PHD 3, GERSHON HOLCBERG 4, MOSHE MAZORS; 1Soroka University Medical Center, geer-Sheva; '-'Soroka University Medical Centre, OB/GYN, Beer-Sheva; 3Soroka University Medical Center, Epidemiology, Beer~Sheva; 4Ben Gurion University of The Negev, Beer-Sheva; 5Soroka University Medical Centre; Beer-Sheva

OBJECTIVE: The aim of this study is to evaluate whe the r glucose in tolerance dur ing p regnancy is associated with the development of pre- eclampsia.

STUDY DESIGN; A retrospective case control study was des igned that included patients who developed pregnancy induced hypertension or pre- eclampsia at their current pregnancy (n = 132). A similar number of patients with normal obstetric history and uneventful cur rent pregnancy were used as control group. Inclusion criteria were singleton pregnancy and appropriate prenatal care. Exclusion criteria were pregestational and gestational diabetes, chronic hypertension, chronic steroid t reannent and other metabolic diseases that influence glucose metabolism, Data concern ing fasting glucose levels, glucose challenge test (GCT) and oral glucose tolerance tests were collected from patient 's files.

RESULTS: In the study group mean mate/'nal age, mean GCT levels and mean gestational body mass index (BMI) were significantly h igher than the control group (28.0 ± 5.8 vs. 26.47 _+ 5.3 P = .026; 104.9 -+ 25.4 vs. 92.27 + 20.4 P - .0018; 30.1 + 4.8 vs. 27.5 -+ 3.5 P < .001, respectively). Mean gestational age and birth weight were significantly lower in the study group (38.5 -+ 2.1 vs. 39.4 _+ 1.7 P < .001; 2929g + 614.7 vs. 3225 -+ 461.1 P < .001, respectively.) A multiple logistic regression was per formed including pathologic GCT, pathologic value of GTT, BMI, maternal age and gestational age. BMI and gestational age were independently associated with preeclampsia (O.R. 1.103 95% C.I. 1.008-1.208; O.R. 0.54 95% C.I. 0.302-0.986).

CONCLUSION; Elevated gestational BMI was an independent risk factor for development of preeclampsia. Abnormal GCT levels are associated with h igher incidence of preeclampsia only in obese patients.

347

December 2001 A m J Obstet Gynecol

THE UTILITY OF COMMON CLINICAL AND LABORATORY PARAME- TERS TO DISTINGUISH ECLAMPTIC FROM PREECLAMPTIC WOMEN 1N A DEVELOPING COUNTRY MARIA SMALL 1, PATRICK VALSAINT 2, JOSHUA COPEL 1, KEITH WILLIAMS3; 1Yale University, Obstetrics & Gyne- cology, New Haven, CT; 2Hospital Albert Schweitzer, Surgery, Descbapelle; 3Yale University, New Haven, CT

OBJECTIVE: To identify which common clinical and laboratory param- eters on admission best distinguish eclamptic f rom preedampt ic women at the Hospital Albert Schweitzer in rural Haiti.

STUDY DESIGN: We per fo rmed a one-year retrospective review of the hospital char ts of all admissions for p reec lamps ia /ec lamps ia to evaluate whether the available clinical and laboratory tools at the time of hospitali- zation predicted maternal outcome. The factors analyzed were: maternal age, gravidity, hematocri t , creatinine, ur ine protein, systolic and diastolic b lood pressure, presence of fetal demise (IUFD), and gestational age. Analysis was per formed using student t tests with significance set at P < .05.

RESULTS: Of 857 deliveries, 100 deliveries (12%) were complicated by p reedamps ia / ec l amps ia . Sixty-two preeclampt ic and 20 eelamptic records were analyzed. O f seven maternal mortalities in the time period, 6 (86%) were secondary to eclampsia.Only o l igur ia /anur ia was significantly h igher among eclamptics (8/20) than preeclamptics (1/62) P = . 004 (Table).

CONCLUSION: Preeclampsia/eclampsia remains a significant cause of maternal mortality in developing countries. The presence of o l igur ia /anur ia in eclamptics is reflective of the severity of end organ damage in this group. The lack of predictive capabili ty reemphasizes the need for universal aggressive therapy for all preeclamptics in this setting.

Table

PET ECL SIG

Mat. age 28.5 -+ 7.7 24.5 + 6.37 .061 Sys BP 161 + 22.5 162 + 27.4 NS Dias BP 105 -+ 17.5 102 _+ 18.7 NS Hct 32.7 + 7.1 33.9 _+ 5.5 NS Creatinine 1.57 -+ .68 2.1 _+ 1.9 NS Ur Prot 1.95 + 1.02 1.93 -+ 1 NS IUFD 16% 40% NS Oliguria 1,6% 40% .000 Preterm 39% 35% NS Nnllip 35% 16% NS

346 ELEVATED INTERLEUKIN-18 (IL-18) IN PRE-ECLAMPSIA; SENSITIVE AND SPECIFIC COSMAS VAN DE VEN t , HOLLY NATH-BEEMANe, NORAH NAUGHTON 3, DANIEL REMICK4; tUniversity of Michigan, Obstetrics & Gynecology, Ann Arbor, MI; eUniversity of Michigan, OBGYN, Ann Arbor, MI; 3University of Michigan, Anesthesiology, Ann Arbor, MI; 4University of Michigan, Pathology, Ann Arbor, MI

OBJECTIVE: Pre-eclampsia is associated with a dysfunction of the mater- nal vascular endothelium, including an inflammatory response in the maternal spiral arteries similar to graft versus host disease. Previous reports of altered pro- and anti-inflammatory cytokines have been inconsistent and therefore inconclusive. We hypothesized that the ba lance between pro- and anti- inf lammatory cytokines is al tered in preeclampsia in favor of an increased inflammatory response. We included analysis of the pro-inflammatory cytokine Interleukin-18 (IL-18) which thusfar has not been studied in pre-eclampsia and appears to play a role in graft versus host disease in the non-obstetric population.

STUDY DESIGN: Four teen pre-eclamptic pat ients and fifteen non- preeclamptic patients, not in labor, without evidence of an infections process, were enrolled. Blood was obta ined by venipuncture , cent r i fuged and the serum frozen at -20°C. Pro-inilmnmatory (TNF, IL-1, 1L-6, IL-8 and IL-18) and anti-inflammatory (IL-1 receptor antagonist (ra), IL-1 soluble receptor (sr) 2, TNF sr I and II, and IL-10) cytokines were analyzed by an ELISA assay. All assays were run simultaneously.

RESULTS: Eleven of the 14 pat ients b a d severe pre-eclampsia. Mean gestational age was significantly lower in the pre-eclamptic group, 33 vs 38 weeks. The most significant (P< .000l) f inding was the marked increase in IL- 18 in 14 out of 15 patients with pre-eclampsia, mean 262 p g / m k compared to only 1 out of 14 controls having a detectable level of IL-18 (>60pg/ml). The anti-inflammatory cytokines TNF-srl and TNF-sr2 were significantly higher yet the ant i - inf lammatory cytokine IL- l ra was significantly lower in the pre- eclamptic group.

CONCLUSION: IL-18, a pro- inf lammatory cytokine, appears to be significantly upregnla ted in patients with pre-eclampsia. IL-18 is a cytokine repor ted to be associated with graft versus host disease and may become a sensitive and specific marker for pre-eclampsia. Anti-infiammatory cytokines appear both up and down regulated.

348 LABETALOL IS MORE EFFECTIVE AND RELIABLE THAN MGSO4 IN RE- DUCING MATERNAL CEREBRAL PERFUSION PRESSURE IN SEVERELY PREECLAMPTIC WOMEN MICHAEL BELFORT l, GEORGE 8AADE 2, CATHY TOOKE-MILLER 3, ERROL NORWITZ 4, HENRY NISELL 5, CHAR- LOTTA GRUNEWALD 6, DONNA DIZON-TOWNSON]; 1University of UT, OB/GYN, Salt Lake City, Utah; 2University of Texas Medical Branch at Galveston, Obstetrics and Gynecology, Galveston, TX; 3Utah Valley Regional Medical Center, OB/GYN, Provo, UT; 4Harvard Medical School, OB/GYN, Boston, MA; 5Huddinge Hospital , OB/GYN, Stockholm; 6Sodersjukhuset, OB/GYN, Stockholm

OBJECTIVE: To compare cerebral perfus ion pressure (CPP) and its response to MgSO4 and labetalol in severely preeclamptic gravidas.

STUDY DESIGN: Eight severely preeclamptic women receiving labetalol (200rag PO q 6 hr) and 9 severely preeclamptic women given 6g 1V MgSO4 ( then 2 g / h r ) were studied with transcranial Doppler ul t rasound. CPP was measured at the baseline and 2 hours after therapy was started. CPP data were plot ted on normat ive curves for pregnancy. Statistical analysis was with Student 's t test, paired t test, or Mann Whitney U test. P < .05.

RESULTS: Patients ages were similar. Gestadonal age in the patients given labetalol was significantly less than in the MgSO4 group (30 [26-34] vs. B7 [35- 38] weeks). Baseline MAP was similar in both groups (labetalol vs. MgSO4: 115+/-17 vs. 108+/-14 mmHg) . Both groups showed significant decreases in MAP. Baseline CPP was similar in both groups (labetalol vs. MgSO4:107+/-17 vs. 95+/-32 mmHg) . The labetalol group showed a significant decrease in CPP (88+/-10 m m H g at 2 hours) while the MgSO4 group did not (94+/-31 mmHg) . Five of the 9 in the MgSO4 group and 7 /8 of the labetalol group had elevated CPP compared with normal pregnancy. O f those 3 /5 in the MgSO4 group showed a decrease in CPP while all 7 of the labetalol group decreased their CPP after treatment. MgSO4 was associated with a significant increase in heart rate while labetalol was not,

CONCLUSION: Labetalol appears to be more reliable and effective in reducing CPP than MgSO4 in patients with severe preeclampsia. If elevated CPP pressure is important in the etiology of eclampsia, labetalol may be an effective seizure prophylactic agent and this area of research deserves fur ther study.