547

548

424 SPO Abstracts

RISK FACTORS FOR THE RECURRENCE OF GESTATIONAL DIABETES F.L Gaudier", M.G. Pois!", J.e. Hauth, D. Corbett"

The University of Alabama Hospitals, Birmingham

We evaluated the recurrence of gestational diabetes mellitus (GDM) by identifying ninety women with a pregnancy complicated by glucose intolerance and whose subsequent pregnancy was managed at our institution. Forty-seven (52%) of the patients had a recurrence of GDM in their subsequent gestation.

Race (Black) Family History Index Pregnancy

Macrosomia (;,,4OOOg) Glucose values (mg/dl)

Screening Test (1 hr value plasma)

GTT - Fasting 1 hour 2 hour 3 hour

Required Insulin Subsequent pregnancy

BMI ;,,35 Pre-pg wt. (kg) WI. gain in pg (kg) Newborn wt. (gm)

BMI = Body Mass Index

Recurrent (n=47)

79% 57.4%

23%

189:t50

110:t25 228:t43 225:t60 163:t54 69%

34.1% 83.4:t23.2 10.9:t5.7 3479+732

Non-Recurrent (n=43)

84% 46.5%

7.5%

168:t39

99:t22 205:t35 184:t38 158:t42 31%

10.0% 75.0:t22.9 13.1:t7.0 3359:t680

P

0.55 0.30

0.05

0.04

0.42 0.Q1 0.0004 0.63 0.04

0.01 0.09 0.11 0.42

We conclude that women with a prior history of GDM are at increased risk for recurrence. These patients may benefH from earlier screening for glucose intolerance in their subsequent pregnancies and especially those who are obese, had fetal macrosomia, or required insulin during their previous pregnancies.

HblAc PREDICTS PREGNANCY MORBIDITY IN DIABETICS. R. Figueroa, U. Verma, F. Wiltshire~ N. Tejani. Dept. of Ob/Gyn, NY Med. ColI., Valhalla, NY.

Objective To evaluate the correlation on in­itial HbAlc and adverse outcome in diabetic pre~ nancies. Study design Medical records of 174 pregnancies in diabetic women were reviewed. ~ formation obtained was initial HbAlc value and gestational age (92 wks., ~20 wks., S24 wks.,>24 wl<s) when obtained, adverse pregnancy outcome(major congenital malformations, spontaneous abortion, fetal death after viability) and normal outcome. Pregnancies were subdivided into HbAlc!: 9%, HbA1c ;>9% - ~12% and HbAlc >12%. Data was analyzed using ANOVA and t-tests. Results Compared to pregnan­cies with normal outcome, HWUc was higher in pregnancies with major congenital malformations (10.2% vs 7.3%; p""O.OI), spontaneous abortions (13.3% vs 7.3%; p(.OO5), and when all adverse out­comes were considered (10.9% vs 7.3%, p(.OO5). A HWUc of> 12% at 92 wks. gestation predicted a 100% morbidity. TABLE

ADVERSE PREGNANCY OUTCOME (CUMULATIVE NI1M.) HbAlc GA (Weeks)

)12% ? 9% ~12% !: 9%

"12 '20 6/6 iO/ll 2/8 3/17 0/6 2/18

~ 24 11/13 5/20 3/27

ALL 11/16

7/27 11/131

Conclusions HbAlc is a reliable predictor of adverse pregnancy outcome.

549

January 1992 Am J Obstet Gynecol

FIXED MINIDOSE WARFARIN FOR PROPHYLAXIS OF nIROMBOEMBOLIC DISEASE IN PREGNANCY: A SAFE

~,r.:~t~c';?"~ ~Jo~e~,S~l&':"'Pr~s~cp,,'$§l?'i:NR·p~~';[.?t~ Program, University of COlorado Health Sciences Center, Denver, COlorado

FIXed minidose warfarin may be effective prophylaxis for venous thrombosis in hii!b risk patients. COmplete anticoagulation with warfarin in the second and ihird tnmester of pregnancy may lead to fetal and maternal bleeding complications. Parenteral bepann by subcutaneous injection or infusion pump is inconvenient, p'ainful and associated with coml1hcations of bleeding, thrombocytoP."nia, ana osteoporosis. The following patient offered the opportunity to study the usefulness and safety of minidose warfarin in late prejtnancy.

Oise ReJ1Ort: A 28 year old para 1 with antithrombin III deficiency suffered a right subclavian vein tlirombosis at 18 weeks gestation and was treated with mtravenous heparin with resolution. Subcutaneous heparin was substituted for prophylactic th~y but was unsuccessful in prolonginJl the partial thromlxiplastic time (yq) to any degree. A continuous 1Orusion pump was reqwred to assure adequate ~OPllyiaxiS' but the patient was unreceptive to prolonged therapy oT this e. Minidose warfarin (1 mg a day) was offered as an alternative at 32 wee gestation. Maternal and felal blOOd samnles were analv<pd at 33 and 36 weeks 'estation.

33 Week 36 Week Maternal Fetal Maternal Fetal

PT 12.3 sec. 14.3 sec. 12.3 sec. 13.4 sec.

n 87% 23% 91% 24%

VII 159% 48% 195% 52%

IX 115% 15% 194% 15%

X 121% 22% 152% 37%

Sonoclot ''hvoer'' "normal" "nonnal" "normal"

Warfarin 1.0 mco/mI O.09mcolml <O.lme<>/mI <O.lmC21mI . 9>nduSlon: Fix . .,j.! nurudose warfann id not result 10 any. arruca

sJgmficant abnormalities of maternal-fetal coagulation. Some Vitamin ¥Z. de~ndent factors in the fetus were mildly depressed. Efficacyof minidose warfarin in pregnancy requires further investigation, though this case study suggests that tfie fetus is not at increased risK of hemorrfiage.

551 LONG-TERM HEALTH OF CHILDREN OF INSULIN DEPENDENT WOMEN

J.E. Converse", Dept of OB/GYN, University of Wisconsin, Madison, WI, M.S. Cranley", School of Nursing, University of Buffalo, Buffalo, NY, and L.B. Curet, Dept of OB/GYN, University of New Mexico, Albuquerque, NM

A retrospective, descriptive study was designed to investigate the health status of children born to insulin dependent diabetic mothers (IDDM). The relationship of the child's health to the maternal obstetrical course was also examined. The convenience sample consisted of 80 children born to 56 predominately married, middle-class, medically insured IDDM mothers who received obstetrical services from a midwestern university perinatal center from the years of 1971 to 1987. The children ranged in age from 7 months to 16 years. Three children had died, 2 in infancy and I in childhood. Conclusion: The results showed that in comparison to general population national health statistics, the children in this study had two to four times greater incidences of child health conditions related to medical, neurological, and developmental problems at birth, in the neonatal period, and throughout childhood. The greater the number of maternal health risk factors, the earlier the infant was born, and the more health problems the child had at birth and in childhood. The differences in child health were not related to the trimester in which prenatal care began with the perinatal program nor correlated with maternal hyperglycemia and elevated glycosylated hemoglobin.