422 spa Abstracts

536 MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS DO NOT INCREASE WITH LABOR C M Meyers, R. N. Andersenx, S. Elias, M. BrownleeX, E. A. TolleyX, J. L. Simpson, Dept. OblGyn, Univ. of Tennessee, Memphis.

The usefulness of second and third trimester maternal serum alpha-fetoprotein (MSAFP) as a predictor of outcome in complicated pregnancies is under investigation. We sought to clarify the effect of labor, a potentially confounding variable in these studies, on MSAFP. In 13 singleton, term pregnancies without antepartum complications, MSAFP was measured at the following times: (1) prior to labor, (2) on admission for delivery, (3) active labor, (4) during the second stage of labor, (5) after delivery, and (6) the first day post partum. MSAFP levels decreased between samples obtained prior to labor (1) and in labor (2 or 3) (p=O.001), and continued to decrease in subsequent samples. One might have predicted the opposite reSUlt, if fetal-maternal transfusion occurs regularly during labor. Conclusions' (1) MSAFP decreases after the onset of labor in comparison to prior samples in uncomplicated, term pregnancies. (2) MSAFP does not increase during labor, suggesting fetal-maternal transfusion during labor is not common in these individuals.

537 LOW FOLATE AND B12 LEVELS AND THE INCIDENCE OF

SPONTANEOUS ABORTIONS. Ran Neiger. MD Charlotte Wise, MD<. Stephen A. Contag. MD, Marea Tumber<, Jacob A Canick. PhD'. Brown University/Women and Infants Hospital. Providence. Rhode Island.

We examined the hypothesis that low folic acid levels around the time of conception were associated with an increased rate of miscarriages. Over a six-months period we obtained folate and BI2leveis on 225

women who presented to Women and Infants Hospital emergency room due to first trimester vaginal bleeding. and studied their pregnancy outcomes. Inclusion criteria were intrauterine pregnancy of less than 14 weeks gestation and HCG>25 mIU/mi. Seventy-four women were excluded due to low HCG levels. ectopic pregnancies. molar pregnancies, elective terminations, or lack of information about pregnancy outcome. Of the 151 women who were included. 99 had normal folate levels ( .. 4.0 ng/mI) and 52 had low folate levels. The average age. gravidity, parity. gestational age and HCG levels at the time of presentation were similar between the two groups. The rate of spontaneous abortions was similar among women with low folate compared with those whose folate was normal (39 of 52 (75%) and 66 of 99 (67%). 1""'0.3). Of the 46 women who delivered a viable newborn, the average gestational age at delivery, birth weights, and 1 and 5 minutes Apgar scores of the two groups were similar. There was no difference in pregnancy outcome among women whose B12 levels were

low compared with those with normal B12 levels. We conclude that

among pregnancies complicated by first trimester vaginal bleeding, folate and BI2 levels appear to have little association with pregnancy

outcome. The benefit of pre-pregnancy folic acid supplementation for improving pregnancy outcome awaits further evaluation.

January 1992 Am J Obstet Gynecol

539 MATBRBAL CAfFBIBB COBSUHPTIOB ABD UMBILICAL ARTBRY VBLOCIHBTRY IB BORHAL TRIRD TRIIlESTBR PRBOBAIICY. L. Devoe. MD, C. Hurray, RB,z A.YOussef, MD,Z. Dept OBGYB, Hed.Coll. of Georgia,Augusta, GA.

Host fetuses receive caffeine ezposure via aaternal ingestion. Since caffeine has vasoactive effects, we sought to deteraine if its chronic aaternal consuaption could influence uabilical artery (UA) resistance. We studied UA Doppler velociaetry of 20 noraal third triaester fetuses, fro. 30 to 40 weeks. Serial systolic:diastolic (S:D) ratios of UAS were obtained every 2 weeks. Values froa Doppler insonation at 3 different intervals(lO cycles each) were averaged for each session. using a previously validated questionnaire, 10 patients were identified as high caffeine consuaers (> 500 ag/day) and 10 as low consuaers « 200 ag/day). Coaparison of S:D ratio trends within each group showed no significant tiae effect(p-.89)or differences between groups (p-.37). Regression plots of aaternal plasaa caffeine levels at each study vs S:D ratio showed no significant correlation (r-.03, p-.83). The level of aaternal caffeine intake does not appear to affect the course of UA Doppler velociaetry observed in noraal pregnancy or, by inference, alter fetal uabilical vascular resistance.

540 UMB/UCAL CORD y..GLUTAMYL TRANSFERASE (GGT): IS IT A MARKER FOR FETAL ASNORMAUTY? Mordechai Hallak, Stanley M. Berry, Jennifer A. Bichalski,x Honor M. WoH, Mark P. Johnson,x Mark I. Evans, David B. Conon; Dept Ob/Gyn; Wayne State Univers~y I Hutzel Hosp~al; Detro~, MI

Normal values for fetal hematologic parameters, blood chemistries, and liver function tests (LFT's) have been previously established. Elevated GGT is a sensitive marker for hepatic dysfunction even though it is produced by other organs including the pancreas, kidney, and heart. Infection and placental insufficiency have both been associated with elevated fetal GGT levels; hepatic inflammation has been implicated in the former condition and hypoxic hepatocellular damage in the laner. Matertal and Methods: We evaluated LFT's and complete blood counts in 30 consecutive fetal blood specimens obtained by cordocentesis. GGT's were obtained on 25 specimens. The indications for cordocentesis included: fetal malformation (12), red blood cell isoimmunization (6), possible fetal infection (5), oligohydramnios (4), advanced maternal age (1), combined problems (2). Mean gestational age was 26.8 ±, 5.0 weeks (range of 19 - 37). Results: All fetal hematologic parameters were within normal limits LFT resu~s were as follows (mean ±, SO)·

LFT's Results Normal Levels

Total protein (g/dl) 3.58 ± 0.78 3.04±,0.06 Albumin (g/dl) 2.17±0.42 2.14±,0.04 Total bilirubin (mg/dl) 1.63±0.33 1.57 ±,0.06 AL T (GPT) (lUll) 8.51 ±4.24 not reported AST (GOT) (lUll) 25.23±8.04 21.1 ±2.0 GGT(IUII) 138.08±, 102.6 24.4±9.6

.. ConclUSions. 1. Fetal GGT levels are Significantly (p < 0.001) elevated in several abnormal fetal conditions. 2. These data suggest that several seemingly unrelated fetal conditions are associated with mild degrees of liver dysfunction; a~ernatively, GGT elevations in these circumstances may be related to other organ systems.