261 BRAIN NATRIURETIC PEPTIDE AS A MARKER FOR HEART DISEASE IN PREGNANCYETOI GARRISON (F)1, JUDITH HIBBARD1, LAURA STUDEE1, DEIDRA FONTANA1,SARAH KILPATRICK1, JOAN BRILLER2, 1University of Illinois at Chicago, Obstet-rics and Gynecology, Chicago, Illinois, 2University of Illinois at Chicago,Cardiology, Chicago, Illinois

OBJECTIVE: Brain Natriuretic Peptide (BNP) is secreted by the heart inresponse to ventricular stretch and volume overload. While BNP has beendemonstrated to be a sensitive marker for left ventricular dysfunction (LVD)in the nonpregnant population, little is known of its utility in pregnancy. Weevaluated the association between BNP and LVD during pregnancy in 39women referred to a cardiology practice from 2003-2005.

STUDY DESIGN: All women presented during pregnancy or postpartum withclinical findings suggestive of decompensated cardiac disease, including dyspnea,pulmonary edema, tachycardia, chest pain, and history of cardiac disease.-Echocardiography andBNPwere obtained in all patients for clinical indications.Ejection fraction was determined by an experienced echocardiographer andcategorized as normal, mild (EF=40-50%), moderate (EF=30-40%), orseverely depressed (EF! 30%). Differences between continuous variables werecalculated using mean G S. E. Categorical data was analyzed by Chi Squareor Fisher’s Exact Test, p!0.05 was considered significant. Regression analysiswas used to determine the association between variables.

RESULTS: There was a significant association between mild to severe LVDand BNP level [R2 0.538, p!0.005]. BNP O100 pg/ml had a sensitivity of72.7%, specificity of 32.1%, positive predictive value of 47%, and a negativepredictive value of 86% for mild to severe LVD. Those diagnosed with acutecardiac decompensation (ACD) (n=9) had significantly higher mean BNPon initial presentation (730.5 pg/ml G 53.7) compared to those without(81.5 pg/ml G 14.7, p!0.05). There was no significant association betweenmild to severe LVD and BNP O 100 pg/ml in those patients without ACD[OR 1.50, 95% CI 0.14-14.9]. Causes of acute cardiac decompensation in-cluded peripartum cardiomyopathy (n= 5), hypertrophic cardiomyopathy(n=2), valvular heart disease (n=1), and non ST elevation MI (n=1).

CONCLUSION: BNP may be useful in identifying acute cardiac decompen-sation in symptomatic women during pregnancy.

262 BREAST CANCER DURING PREGNANCY: MATERNAL AND FETAL OUTCOMESDZHAMALA GILMANDYAR1, DIANE ROBINSON2, ELYCE CARDONICK2, 1Universityof Medicine and Dentistry of New Jersey, Pennsauken, New Jersey, 2CooperHospital, Obstetrics and Gynecology, Camden, New Jersey

OBJECTIVE: Objective of this cohort study is to collect information aboutthe diagnosis and treatment of breast cancer during pregnancy and its effectson maternal and fetal health.There have been few prospective studies ofwomen diagnosed with breast cancer during pregnancy.

STUDY DESIGN: Pregnant women diagnosed with breast cancer duringpregnancy agreed to participate in a prospective cohort study.Details aboutthe diagnosis and treatment of cancer, pregnancy outcome, maternal andneonatal follow up were collected.

RESULTS: Of the 60 women diagnosed during pregnancy, 3 electedtermination, and 1 had a 10 week spontaneous loss. The majority of womenwere diagnosed with stage 2 disease. Six women reported a delay of 5-20 weeksbetween symptoms and diagnosis. The mean age at diagnosis was 35 G4.4years. Cancer types: infiltrating ductal 84% (47/56), inflammatory carci-noma 5% (3/56), lobular carcinoma 5% (3/56) and DCIS 3% (2/56), and5 unknown. Sixty-seven percent of tumors were estrogen receptor negative.Chemotherapy: 42 (79%) Adriamycin/Cytoxan, 4 (7.5%) Adriamycin/Cy-toxan/5-Flurouracil, 3 (5.5%), Epirubicin/Cytoxan, 2 (3.5%), Adriamycin/Cytoxan/Taxotere, 5 unknown. Complications included preterm labor andpreeclampsia. Mean gestational age at diagnosis 15.3 G 7.88 weeks. Meangestational age at first chemotherapy treatment 20.3 G 5.5weeks. Meangestational age at delivery 36.1 G 2.5 weeks and mean birthweight 2645 G 567grams. Neonatal follow up, with the oldest child age 6 years, shows 54/56(96%) are doing well and meeting developmental milestones. Maternal followup reveals 7 women are deceased from recurrent disease, which occurred at amean of 23 months after delivery. One additional recurrence occured afterpregnancy and was successfully treated.

CONCLUSION: Breast cancer can be safely treated during pregnancy, anddelay in diagnosis must be avoided. Maternal survival (6 weeks-6 years) is87.5%. Chemotherapy after 12 weeks is relatively safe for the fetus.

263 OBSTETRIC AND NEONATAL OUTCOMES OF EPILEPSY IN PREGNANCYWILLIAM GOODNIGHT (F)1, MYLA EBELING2, THOMAS HULSEY2, ROGER NEWMAN1,1MedicalUniversity of South Carolina, Obstetrics andGynecology, Charleston,South Carolina, 2Medical University of South Carolina, Pediatrics, Charleston,South Carolina

OBJECTIVE: To describe the obstetrical and neonatal outcomes associatedwith epilepsy in pregnancy.

STUDY DESIGN: A retrospective cohort of live births among women withepilepsy was compared to those deliveries uncomplicated by epilepsy between1992-2004. The patients were identified using the Perinatal Information Systemdatabase. Maternal and neonatal outcomes were compared with Chi-Squareand Fishe’s Exact Test to analyze categorical data and the Student’s t-test forcontinuous variables.

RESULTS: Of 25,304 live births, 196 (186 pregnancies) were delivered bymothers with prepregnancy epilepsy, for a rate of 7.7/1000 births. Antiepilepticdrug (AED) use was reported in 30.1% of patients with prepregnancy epilepsy.Patients with epilepsy had a significant increase in SGA (!10%tile) neonates(15.8% vs 10.7%; p=0.006), and smaller birth weights overall (2746g vs2904g; p=0.007), primarily among the term infants (2982g vs 3139g;p=0.0028). There was no difference in the rate of diabetes, hypertension,preeclampsia, gestational age at delivery, or preterm birth (!37 weeks). Theroute of delivery was similar and there was no difference in labor inductionrates. Patients with epilepsy had a significant increase in the diagnosis ofeclampsia (5.4% vs 0.2%; p!0.0001). The rate of congenital malformation(CM) was increased (7.1% vs 2.3%; p!0.0001). The increased rate of CMpersisted even in the absence of reported AED exposure (5.8% vs 2.4%;p=0.007).

CONCLUSION: Pregnancy in epileptic mothers carries an increased risk ofeclampsia and term SGA. This study confirms an increase in congenitalmalformation in neonates of mothers with epilepsy, independent of AEDexposure.

Congential malformations in epilepsy (%)

Outcome Epilepsy No epilepsy p

VSD 3.03 0.82 0.0198Hydrocephaly 1.53 0.31 0.0221Meningocele 1.02 0.14 0.0312Omphalocele 1.53 0.11 0.0015Cleft Palate 1.02 0.14 0.0312Tetralogy of Fallot 1.02 0.10 0.0184

264 INSULIN GLARGINE: IS IT A VIABLE OPTION FOR MANAGING DIABETES INPREGNANCY TIFFANIE TATE-MOORE1, KELLY BENNETT1, CORNELIA GRAVES1,STEVEN GABBE2, TRACIE THIBAULT1, THERESA SCOTT3, LILY WANG3, 1VanderbiltUniversity, Obstetrics and Gynecology, Nashville, Tennessee, 2Vanderbilt Uni-versity, Nashville, Tennessee, 3Vanderbilt University, Biostatistics, Nashville,Tennessee

OBJECTIVE: Tight glycemic control in pregnant patients with insulin-dependent diabetes reduces the risk of fetal anomalies, but is frequently com-plicated by maternal hypogycemia and proliferative retinopathy. Glargineinsulin has been shown to decrease nocturnal hypoglycemia, however, thereare concerns about its use in pregnancy due its affinity for growth factor. Thisstudy was performed to compare standard insulin regimens, including theinsulin pump, to glarine insulin in the treatment of pregnant patients with pre-existing diabetes.

STUDY DESIGN: This retrospective review examined 27 pregnancies in 25patients with insulin dependent diabetes treated at our center from 2002-2004.Analysis of covariance (ANCOVA) was used to compare patients treated withNPH/regular or the insulin pump to patients treated with glargine. Initial (pre-treatment) HbA1C and 3rd trimester (post-treatment) HbA1C were used forcomparison. Rates of NICU admission, macrosomia, progression of retinop-athy or hypoglycemia (!60 mg/dl) were compared by Fisher exact test.P!0.05 was considered statistically significant.

RESULTS: No significant difference in mean initial HbA1C existed betweentreatment groups. Third trimester HbA1C decreased in all treatment groups.There no significant progression of retinopathy in either treatment group.Macrosomia was observed in 10% infants in the glargine treatment group andin 37% of infants treated with the standard regimens. Hypoglycemia was twiceas frequent in the standard treatment group (35%) as the glargine group(16%), however this did not reach statistical significance.

CONCLUSION: Insulin glargine is effective in the treatment of insulin-dependent diabetes in pregnant pateints, and is not associated with increasedrates of maternal hypoglycemia or proliferative retinopathy, when comparedto standard therapy.

SMFM Abstracts S83