Incidence of cardiomegaly in stillborn infants of diabetic mothers
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305 INCIDENCE OF CARDIOMEGALY IN STILLBORN INFANTS OF DIABETIC MOTHERS NOREEN RUSSELL 1 , PETER HOLLWAY 1 , STEPHEN QUINN 1 , PETER KELEHAN 1 , MICHAEL FOLEY 2 , FIONNUALA MCAULIFFE 2 , 1 National Maternity Hospital, Dublin, Ireland, 2 University College Dublin, Obstetrics and Gynaecology, Dublin, Ireland OBJECTIVE: The role of cardiomegaly in the risk of sudden unexplained death in-utero is unclear. The study hypothesis is that cardiomegaly in the fetus contributes to the risk of sudden death in –utero. The aim of the study is to report the incidence of cardiomegaly in stillborn normally formed infants of diabetic mothers and to compare this with the incidence of cardiomegaly in stillborn normally formed macrosomic infants (O90th centile) and stillborn normally formed appropriately grown infants (10-90th centile) without abruption and for whom no cause of stillbirth was identified. STUDY DESIGN: This is a retrospective study of hospital annual reports from 1985 to 2002 with institutional ethics approval. Cardiomegaly was defined as greater than 2 standard deviations above the mean weight for that gestational age (Wigglesworth et al). Additionally blinded to the clinical details, the pathologists (PH and PK) reviewed the histology slides to record the presence or absence of myocardial fibre disarray, a known feature of cardiomyopathy in adults. RESULTS: Over this 17 year period there were 28 stillborn infants in mothers with either insulin dependant diabetes or gestational diabetes, 26 of these had post-mortem examination. Of these 26, 7 had evidence of cardio- megaly (27%). There were 19 stillborn infants that were macrosomic without maternal diabetes and 5 of these had cardiomegaly on post-mortem (26%). None of the stillborn infants that were appropriately grown had evidence of cardiomegaly (0/103). Stillborn macrosomic and stillborn infants of diabetic mothers were more likely to show cardiomegaly on post-mortem (p!0.01). Myocardial disarray was evident in only 1 case of diabetic cardiomegaly, suggesting that this histological parameter is not a feature of diabetic cardiomyopathy. CONCLUSION: Cardiomegaly may contribute to the risk of fetal death in macrosomic infants and infants of diabetic mothers. Myocardial disarray does not appear to be a constant histological characteristic of diabetic related fetal cardiomegaly. 306 AMNIOTIC FLUID VOLUME AND BIRTH WEIGHT: IS THERE A RELATIONSHIP? JOY VINK 1 , SARAH POGGI 2 , ALESSANDRO GHIDINI 2 , CATHERINE SPONG 2 , 1 George- town University Hospital, Department of Obstetrics and Gynecology, Wash- ington, District of Columbia, 2 INOVA Alexandria Hospital, Perinatal Diagnostic Center, Alexandria, Virginia OBJECTIVE: Previous studies have demonstrated a dichotomous relation- ship between macrosomia (O4000g) and polyhydramnios (O25 cm), partic- ularly in patients with diabetes mellitus (DM). Our objective was to see if this relationship is linear across birthweights (BW). STUDY DESIGN: We accessed a cohort of amniocentesis cases for lung maturity studies with amniotic fluid index (AFI) obtained %7 days of delivery and BW available (n=112). Indications for amniocentesis were poorly controlled DM (52%), other obstetric complications (25%) and need to plan repeat CD (23%). Gestational age (GA) specific AFI and BW centiles were computed using standard tables. Regression analysis was performed to evaluate the relationship between AFI and BW centile and to identify confounders among underlying medical/obstetrical conditions. Statistical analysis included regression, ANOVA and Fisher´s exact where appropriate with P!0.05 significant. RESULTS: The average GA at AFI was 36.6G1.2 weeks and at delivery was 36.9Gweeks, with average BW of 3170Ggrams. We found a linear relation- ship between AFI and BW centiles, such that the babies with largest BW centiles had the highest AFI centiles (P=0.0007). When diabetic patients were analyzed separately, the relationship remained significant (P=0.001), whereas it was no longer present among nondiabetics (P=0.4). CONCLUSION: The previously noted relationship between amniotic fluid volume and BW is shown to be linear in diabetic patients with poor control. This relationship was not observed in nondiabetic patients in our population. 307 INVESTIGATION OF DYNAMIC CHANGES AND CORRELATED FACTORS ON TNF-A ´ LEPTINADIPONECTIN IN PREGNANT WOMEN WITH ABNORMAL GLUCOSE METABOLISM HUIXIA YANG 1 , 1 Beijing University, Ob & GYN, Beijing, China OBJECTIVE: To investigate the serum concentrations of TNF-a´, leptin and adiponectinthe factors related with insulin resistance in pregnant women with GDM or GIGT before diagnosis and their dynamic change during pregnancy, and analyze their correlated factors. STUDY DESIGN: Ninety two pregnant women were selected, including 38 GDM, 14 GIGT and 40 normal control women, by using Nested Case Control. Blood samples were collected during 14-20 GWs, 19 GDM, 13 GIGT and 20 control were sampled during 24-32 GWs, when abnormal 50g GCT or OGTT were diagnosed. ElISA assay was used to measure the level of TNF-a´ leptin and adiponectin respectively. RESULTS: 1.There were significant differences between the serum concen- trations of different factors in GDM, GGIGT and control group, TNF-a´: 170.38G32.66 pg/ml, 72.11G23.59 pg/ml, 35.02G12.39 pg/ml; leptin: 14.16G 3.41 ng/ml, 9.60G1.37 ng/ml, 5.15G1.49 ng/ml; adiponectin: 4.61G1.31 ng/ml, 6.38G1.38 ng/ml, 9.06G1.80 ng/ml during 14-20 GWs P!0.05.The levels of TNF-a´, leptin in GDM group were significant higher than the control group, the level of adiponectin in GDM group was significant lower than control group. 2. There were significant differences in the serum levels of TNF-a´ (GDM 290.61G60.05 pg/ml, GIGT 138.43G21.90 pg/ml and control 58.37G21.44 pg/ml) leptin (GDM 22.64G5.80 ng/ml, GIGT 15.11G2.75 ng/ml and control group 8.88G2.41 ng/ml), adiponectin (GDM 3.00G1.03 ng/ml,GIGT 4.50G 1.42 ng/ml, control group 5.70G1.60 ng/ml) of the three groups in 24-32 GWs P!0.05. 3. BMI had positive correlation with TNF-a´ , leptin, and negative correlation with adiponectin . CONCLUSION: The serum concentrations of TNF-a´, leptin and adiponectin change significantly in pregnant women with GDM or GIGT before diagnosis .During normal pregnancy, the serum levels of TNF-a´, leptin increase and adiponectin decreases . In the pregnant women with abnormal glucose meta- bolism, levels of the three factors change strikingly. BMI are correlated with the serum concentrations of TNF-a´, leptin and adiponectin. 308 METABOLIC SYNDROME AND GESTATIONAL DIABETES: IS THERE A DIFFERENCE IN ADVERSE PREGNANCY OUTCOME? YARIV YOGEV 1 , ODED LANGER 1 , 1 St. Luke’s- Roosevelt Hospital Center, University Hospital of Columbia University, Obstetrics and Gynecology, New York, New York OBJECTIVE: In non pregnancy the diagnosis criteria for metabolic syn- drome (MS) are at least 3 abnormalities out of obesity, dyslipidemia, chronic hypertension (CHTN), insulin resistance and abnormal glucose tolerance. However, no definition exists for MS during pregnancy. We aimed to determine if pregnancy outcome is differed in women with GDM in compar- ison to those with diagnostic criteria fitting MS. STUDY DESIGN: Out of 4,920 GDM women, we identified a subset of women characterized with pre-pregnancy CHTN and obesity (BMI R 30 kg/ m 2 ); these GDM patients were defined as having metabolic syndrome (MS). Pregnancy outcome was compared to GDM patients without MS. Mean blood glucose !105 mg/dl was defined well controlled. RESULTS: 1) The rate of MS was 10.9% (536/4,920) in the GDM group. 2) The GDM-MS group was older, with higher parity and family history of diabetes, screened earlier for GDM, and had higher OGTT fasting values in comparison to GDM patients. 3) No difference was found between the groups in weight gain during pregnancy, gestational age at delivery or mean birth- weight. 4) The rate of insulin use was 62% in the GDM-MS and 47% in the GDM only group, (p!0.001). 5) No difference was found in the level of glycemic control, fetal macrosomia, growth restriction (SGA), cesarean sec- tion, NICU admissions and metabolic complications between the groups. 6) The rates of preeclampsia (6.6 vs. 14.6, p!0.02) and premature labor (18.6 vs. 10.1, p!0.001) was higher in the GDM-MS in comparison to GDM alone. CONCLUSION: Metabolic syndrome in GDM patients is associated with increased rates of preeclampsia and pre-term labor. In contrast, neonatal complications are similar for both groups. 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Transcript of Incidence of cardiomegaly in stillborn infants of diabetic mothers
305 INCIDENCE OF CARDIOMEGALY IN STILLBORN INFANTS OF DIABETIC MOTHERSNOREEN RUSSELL1, PETER HOLLWAY1, STEPHEN QUINN1, PETER KELEHAN1,MICHAEL FOLEY2, FIONNUALA MCAULIFFE2, 1NationalMaternityHospital,Dublin,Ireland, 2University College Dublin, Obstetrics and Gynaecology, Dublin,Ireland
OBJECTIVE: The role of cardiomegaly in the risk of sudden unexplaineddeath in-utero is unclear. The study hypothesis is that cardiomegaly in thefetus contributes to the risk of sudden death in –utero. The aim of the study isto report the incidence of cardiomegaly in stillborn normally formed infants ofdiabetic mothers and to compare this with the incidence of cardiomegaly instillborn normally formed macrosomic infants (O90th centile) and stillbornnormally formed appropriately grown infants (10-90th centile) withoutabruption and for whom no cause of stillbirth was identified.
STUDY DESIGN: This is a retrospective study of hospital annual reportsfrom 1985 to 2002 with institutional ethics approval. Cardiomegaly wasdefined as greater than 2 standard deviations above the mean weight for thatgestational age (Wigglesworth et al). Additionally blinded to the clinicaldetails, the pathologists (PH and PK) reviewed the histology slides to recordthe presence or absence of myocardial fibre disarray, a known feature ofcardiomyopathy in adults.
RESULTS: Over this 17 year period there were 28 stillborn infants inmothers with either insulin dependant diabetes or gestational diabetes, 26 ofthese had post-mortem examination. Of these 26, 7 had evidence of cardio-megaly (27%). There were 19 stillborn infants that were macrosomic withoutmaternal diabetes and 5 of these had cardiomegaly on post-mortem (26%).None of the stillborn infants that were appropriately grown had evidence ofcardiomegaly (0/103). Stillborn macrosomic and stillborn infants of diabeticmothers were more likely to show cardiomegaly on post-mortem (p!0.01).Myocardial disarray was evident in only 1 case of diabetic cardiomegaly,suggesting that this histological parameter is not a feature of diabeticcardiomyopathy.
CONCLUSION: Cardiomegaly may contribute to the risk of fetal death inmacrosomic infants and infants of diabetic mothers. Myocardial disarray doesnot appear to be a constant histological characteristic of diabetic related fetalcardiomegaly.
306 AMNIOTIC FLUID VOLUME AND BIRTH WEIGHT: IS THERE A RELATIONSHIP?JOY VINK1, SARAH POGGI2, ALESSANDRO GHIDINI2, CATHERINE SPONG2, 1George-town University Hospital, Department of Obstetrics and Gynecology, Wash-ington, District of Columbia, 2INOVA Alexandria Hospital, PerinatalDiagnostic Center, Alexandria, Virginia
OBJECTIVE: Previous studies have demonstrated a dichotomous relation-ship between macrosomia (O4000g) and polyhydramnios (O25 cm), partic-ularly in patients with diabetes mellitus (DM). Our objective was to see if thisrelationship is linear across birthweights (BW).
STUDY DESIGN: We accessed a cohort of amniocentesis cases for lungmaturity studies with amniotic fluid index (AFI) obtained %7 days of deliveryand BW available (n=112). Indications for amniocentesis were poorlycontrolled DM (52%), other obstetric complications (25%) and need to planrepeat CD (23%). Gestational age (GA) specific AFI and BW centiles werecomputed using standard tables. Regression analysis was performed toevaluate the relationship between AFI and BW centile and to identifyconfounders among underlying medical/obstetrical conditions. Statisticalanalysis included regression, ANOVA and Fishers exact where appropriatewith P!0.05 significant.
RESULTS: The average GA at AFI was 36.6G1.2 weeks and at delivery was36.9Gweeks, with average BW of 3170Ggrams. We found a linear relation-ship between AFI and BW centiles, such that the babies with largest BWcentiles had the highest AFI centiles (P=0.0007). When diabetic patients wereanalyzed separately, the relationship remained significant (P=0.001), whereasit was no longer present among nondiabetics (P=0.4).
CONCLUSION: The previously noted relationship between amniotic fluidvolume and BW is shown to be linear in diabetic patients with poor control.This relationship was not observed in nondiabetic patients in our population.
307 INVESTIGATION OF DYNAMIC CHANGES AND CORRELATED FACTORS ONTNF-A LEPTINADIPONECTIN IN PREGNANT WOMEN WITH ABNORMAL GLUCOSEMETABOLISM HUIXIA YANG1, 1Beijing University, Ob & GYN, Beijing, China
OBJECTIVE: To investigate the serum concentrations of TNF-a, leptin andadiponectinthe factors related with insulin resistance in pregnant women withGDM or GIGT before diagnosis and their dynamic change during pregnancy,and analyze their correlated factors.
STUDY DESIGN: Ninety two pregnant women were selected, including 38GDM, 14 GIGT and 40 normal control women, by using Nested Case Control.Blood samples were collected during 14-20 GWs, 19 GDM, 13 GIGT and 20control were sampled during 24-32 GWs, when abnormal 50g GCT or OGTTwere diagnosed. ElISA assay was used to measure the level of TNF-a leptinand adiponectin respectively.
RESULTS: 1.There were significant differences between the serum concen-trations of different factors in GDM, GGIGT and control group, TNF-a:170.38G32.66 pg/ml, 72.11G23.59 pg/ml, 35.02G12.39 pg/ml; leptin: 14.16G3.41 ng/ml, 9.60G1.37 ng/ml, 5.15G1.49 ng/ml; adiponectin: 4.61G1.31 ng/ml,6.38G1.38 ng/ml, 9.06G1.80 ng/ml during 14-20 GWs P!0.05.The levels ofTNF-a, leptin in GDM group were significant higher than the control group,the level of adiponectin in GDM group was significant lower than controlgroup. 2. There were significant differences in the serum levels of TNF-a (GDM290.61G60.05 pg/ml, GIGT 138.43G21.90 pg/ml and control 58.37G21.44pg/ml) leptin (GDM 22.64G5.80 ng/ml, GIGT 15.11G2.75 ng/ml and controlgroup 8.88G2.41 ng/ml), adiponectin (GDM 3.00G1.03 ng/ml,GIGT 4.50G1.42 ng/ml, control group 5.70G1.60 ng/ml) of the three groups in 24-32GWs P!0.05. 3. BMI had positive correlation with TNF-a, leptin, and negativecorrelation with adiponectin .
CONCLUSION: The serum concentrations of TNF-a, leptin and adiponectinchange significantly in pregnant women with GDM or GIGT before diagnosis.During normal pregnancy, the serum levels of TNF-a, leptin increase andadiponectin decreases . In the pregnant women with abnormal glucose meta-bolism, levels of the three factors change strikingly. BMI are correlated withthe serum concentrations of TNF-a, leptin and adiponectin.
308 METABOLIC SYNDROME AND GESTATIONAL DIABETES: IS THERE A DIFFERENCE INADVERSE PREGNANCY OUTCOME? YARIV YOGEV1, ODED LANGER1, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University,Obstetrics and Gynecology, New York, New York
OBJECTIVE: In non pregnancy the diagnosis criteria for metabolic syn-drome (MS) are at least 3 abnormalities out of obesity, dyslipidemia, chronichypertension (CHTN), insulin resistance and abnormal glucose tolerance.However, no definition exists for MS during pregnancy. We aimed todetermine if pregnancy outcome is differed in women with GDM in compar-ison to those with diagnostic criteria fitting MS.
STUDY DESIGN: Out of 4,920 GDM women, we identified a subset ofwomen characterized with pre-pregnancy CHTN and obesity (BMI R 30 kg/m2); these GDM patients were defined as having metabolic syndrome (MS).Pregnancy outcome was compared to GDM patients without MS. Mean bloodglucose !105 mg/dl was defined well controlled.
RESULTS: 1) The rate of MS was 10.9% (536/4,920) in the GDM group. 2)The GDM-MS group was older, with higher parity and family history ofdiabetes, screened earlier for GDM, and had higher OGTT fasting values incomparison to GDM patients. 3) No difference was found between the groupsin weight gain during pregnancy, gestational age at delivery or mean birth-weight. 4) The rate of insulin use was 62% in the GDM-MS and 47% in theGDM only group, (p!0.001). 5) No difference was found in the level ofglycemic control, fetal macrosomia, growth restriction (SGA), cesarean sec-tion, NICU admissions and metabolic complications between the groups. 6)The rates of preeclampsia (6.6 vs. 14.6, p!0.02) and premature labor (18.6 vs.10.1, p!0.001) was higher in the GDM-MS in comparison to GDM alone.
CONCLUSION: Metabolic syndrome in GDM patients is associated withincreased rates of preeclampsia and pre-term labor. In contrast, neonatalcomplications are similar for both groups.
S94 SMFM Abstracts
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