169

170

171 THE EFFECT OF DEPOT MEDROXYPROGESTERONE ACETATE ON 2-HOUR GLUCOSE TOLERANCE TESTING IN POSTPARTUMGESTATIONAL DIABETES ENZIE BRISKEY1, MARY CONNELLY1, HUGHMILLER1, 1University of Arizona, Obstetrics and Gynecology, Tucson, AZ

OBJECTIVE: The purpose of this study is to determine the effect of depotmedroxyprogesterone acetate (DMPA) on the 2-hour postpartum (PP) oralglucose tolerance test (OGTT) in patients diagnosed with gestational diabetes(GDM).

STUDY DESIGN: A retrospective multicenter cohort study encompassing437 patients with gestational diabetes treated between 1996 and 2000. Thosepatients were divided into two subgroups, those who received DMPA and thosewho chose a non-hormonalmethod of contraception. The primary outcome wasto compare the rate of glucose intolerance between groups. Secondary outcomemeasures consisted of BMI, family history of GDM, personal history of GDM inprior pregnancies, A1 and A2 GDM, gestational age at diagnosis, and birthweight to glucose intolerance. The non-hormonal and DMPA groups werecompared using the 2-tailed unpaired Student’s t-test and Fisher’s exact test.

RESULTS: There were 172 patients who received a postpartum OGTTwhowere either on DMPA or a non-hormonal method of contraception. There were125 (73%) in the non-hormonal group and 47 (27%) in the DMPA group.Maternal age, registration BMI, delivery BMI, PP BMI, birth weight, familyhistory of GDM, prior history of GDM, and gestational age at diagnosis of thisindex pregnancy were not significantly different. 4 of 73 (5%) of A1 GDM and31/99 (31%) of the A2 GDM had abnormal PP OGTT for a RR 1.7, 95% Cl 1.45to 2.19. 26 of 125 (20.8% of the non-hormonal group had impaired glucosetolerance, compared to 9 of 47 (19.1%) in the DMPA group (P = NS).

CONCLUSION: DMPA does not influence PP glucose intolerance.

December 2003Am J Obstet Gynecol

S110 SMFM Abstracts

IS SHOULDER DYSTOCIA-ASSOCIATED BRACHIAL PLEXUS PALSYMORE SEVERE AMONG INFANTS OF DIABETICS? SCOTT PETERSEN1,ROBERT ALLEN2, MICHELE DONITHAN3, PATRICIA MOORE4, LEORAALLEN5, KATHERINE OUTLAND2, EDITH GUREWITSCH1, 1Johns Hop-kins University, Gyn/Ob, Baltimore, MD 2Johns Hopkins University, BiomedEng, Baltimore, MD 3Johns Hopkins University, Epidemiology, Baltimore,MD 4Johns Hopkins University, Gyn/Ob, Baltimore, MD 5Johns HopkinsUniversity, Nursing, Baltimore, MD

OBJECTIVE: Diabetic gravidas are at increased risk for shoulder dystocia(SD). Infants of diabetic mothers (IDM) are at risk for abnormalities of theirnervous system. To test the hypothesis that among neonates with SD-associatedbrachial plexus palsy (BPP) permanent and severe BPP ismore prevalent amongIDM, we compared rates of permanent and severe BPP between IDM and non-IDM.

STUDY DESIGN: Cases of SD-associated BPP culled from 2 databases (allSD deliveries [1993-2003] from a single institution and litigated cases of SD-associated permanent BPP from multiple U.S. institutions) were classified astemporary if BPP resolved by 2 yrs of age (TBPP). Permanent BPP was classifiedas severe if it lasted more than 2 yrs and involved the complete brachial plexus(C5-C8/T1) and/or a nerve root avulsion (SBPP). Mild permanent BPI lasted$2 yrs but did not involve the lower nerve roots or an avulsion (MBPP). Non-IDM and IDM were compared for rates of permanent BPP and of SBPP, usingchi-square with significance set at P < 0.05. A stepwise linear regression modelwas used to evaluate the effect of diabetes on permanence and severity of BPP.

RESULTS: Of 218 cases of SD-associated BPP, the maternal diabetic statuswas known in 208 (95.4%). Of these, 56 were TBPP, 89 were MBPP, and 63 wereSBPP. While macrosomia was equally prevalent among TBPP as amongpermanent BPP, infants with SBPP were more likely to be macrosomic thaninfants with TBPP or MBPP (77.2% vs 61.2%, P = 0.02). However, macrosomiawas no more common among diabetics than among non-diabetics in this selectpopulation of infants with SD-associated BPP. After controlling for maternalweight and birth weight, infants of diabetics were no more likely to have eitherpermanent or severe BPP than infants of non-diabetics.

CONCLUSION: IDM with SD-associated BPP are not at increased risk foreither permanent or severe BPP.

Table. Correlation of Diabetes with Permanence and Severity of BPP

non-IDM (N = 167) IDM (N = 41) P value

Perm BPP 94 (56.3%) 18 (43.9%) 0.15SBPP 48 (28.7%) 15 (36.6%) 0.33

A 2D-3D ULTRASOUND STUDY OF YOLK SAC IN PREGNANCIESCOMPLICATED BY DIABETES MAURIZIO ANCESCHI1, ERICH COSMI2,JUAN PIAZZE1, ERMELANDO V. COSMI1, 1University of Rome La Sapienza,Inst. Gynecology, Perinatology and Child Health, Rome, Italy 2University ofSassari, Inst. Obstetrics & Gynecology, Sassari, Italy

OBJECTIVE: To assess, by means of bidimensional and three-dimensionalultrasound, the diameter and the volume of the yolk sac in pregnant womenaffected by type 1 diabetes in the first trimester of pregnancy.

STUDY DESIGN: Eighteen women affected by type 1 diabetes (IDDM) andeleven normoglycemic pregnancies as controls were considered. Pregnantwomen were evaluated once a week (from the 5th to 12th week of pregnancy).The ultrasound examination was initially performed in 2-D fashion witha transvaginal 6.5-MHz probe and subsequently by 3-D procedure.

RESULTS: In the pregnant diabetic women, the diameter of the yolk sacoverlapped that of controls in the first weeks of pregnancy; nevertheless, fromthe 7th-8th week, the diameter was significantly greater with a maximumdiameter of 6.6 mm ,,b 0.8 (6.0 mm ,,b 0.6 in the controls) (P < .05) by 9th week,afterwards decreasing more precociously in comparison with controls. Thevolume of the yolk sac increased in both groups, beginning from the 5th week ofpregnancy with maximum values at 10th week in the group of normalpregnancies and at 9th week in the diabetic pregnant women.

CONCLUSION: The clinical and diagnostic significance of the volume ofyolk sac in pregnant diabetic women is still to be defined. This determinationmay represent an additional tool in themonitoring of pregnant diabetic womenin early pregnancy.

Supported by MIUR, Italy.

172 THE SIGNIFICANCE OF AN ELEVATED FASTING VALUE ON THEGLUCOSE TOLERANCE TEST AND A MARKEDLY ELEVATED GLUCOSECHALLENGE TEST IN ASSESSING PREGNANCY OUTCOME WILSONQUEZADA1, DOROTHY SMOK1, GEORGE GRAHAM, III1, PATRICIADEVINE2, 1Columbia University, Obstetrics and Gynecology, New York, NY2Columbia University, New York, NY

OBJECTIVE: To determine if patients with gestational diabetes (GDM) anda significantly elevated glucose challenge test (GCT) or fasting value on glucosetolerance test (GTT) are at increased risk for adverse pregnancy outcome.

STUDY DESIGN: A retrospective review of patients with GDM wasperformed. GDM was diagnosed if the GCT was >200 mg/dL, or 2 or moreelevations on the GTT (fasting, 1-, 2-, and 3-hr values of 95, 180, 155, and 140,respectively). Patients were stratified into 3 groups: Group1 (fasting glucose< 95), Group 2 (fasting >95), and Group 3 (GCT >200). Chart review wasperformed to assess pregnancy outcome. Pregnancy outcome values includedthe need for insulin, birthweight, birthweight > 4000 gm, and mode of delivery.Statistical analysis was completed using the Fischer’s exact test.

RESULTS: Pregnancy outcomes were reviewed for 229 patients with GDM.Comparison of the need for insulin in pregnancy, mean birthweight,birthweight > 4000 gm, and incidence of cesarean delivery revealed nostatistically significant difference between the three groups. A sub-analysiscomparing patients from Groups 2 and 3 (fasting > 95 or GCT > 200) withGroup 1 (fasting < 95) demonstrated an increase in the incidence of birthweight> 4000 gm (18% versus 8%, P 0.071) and delivery by cesarean section (88%versus 45%, P 0.067).

CONCLUSION: Pregnancies complicated by a significantly elevatedGCToran elevated fasting value on the GTT are more likely to result ina birthweight > 4000 gm and a cesarean delivery.

Pregnancy outcome

Fasting < 95(n = 62)

Fasting >95(n = 107)

GCT >200(n = 60)

P value

Insulin 54% 50% 61% 0.30Birthweight (gm) 3367 ± 462 3516 ± 538 3451 ± 629 0.20Birthweight > 4000 gm 5% 19% 9% 0.20C/S 45% 56% 32% 0.18