Volume 164 Number I, Part 2

121 PRECONCEPTIONAL MANAGEMENT OF INSULIN-DEPENDENT DIABETICS: IMPROVEMENT OF PREGNANCY OUTCOME. Barak Rosenn. M.D., Menachem Miodovnik, M.D., Jane Khoury, M.Sc.x, Tariq A. Siddiqi, M.D. University of Cincinnati, Cincinnati, Ohio.

Poor metabolic control before conception and in the early phases of embryogenesis is associated with an increased risk for spontaneous abortions and congenital malformations in insulin-dependent diabetics (IDDs). We hypothesized that (I) IDDs enrolled in a preconception program achieve improved glycemic control early in pregnancy compared to IDDs receiving early prenatal care; (2) these patients will have improved embryonic and fetal survival. We studied 99 pregnant IDDs who enrolled into our program prior to 9 weeks' gestation. Of these, 28 patients had initially attended a preconception clinic (preconception group), and 71 enrolled after conception (early pregnancy group). Glycohemoglobin Al at enrollment, 9 and 14 weeks' gestation, and the rate of spontaneous abortions, were all significantly lower in the preconception group. There was one major malformation occurring in the early pregnancy group. We conclude that IDDs attending a preconception program have improved glycemic control very early in pregnancy and during embryogenesis, and consequently these patients experience a lower rate of spontaneous abortions. We speculate that such programs also contribute to a reduction in the rate of congenital malformations in IDDs.

122 DIABETIC RETINOPATHY IN PREGNANCY: ASSOCIATION WITH EARLY GLYCEMIC CONTROL AND HYPERTENSIVE DISORDERS. Barak Rosenn. M.D., Matthew J. Lipman, M.D.x, Jane Khoury, M.Sc.x, Tariq A. Siddiqi, M.D., Menachem Miodovnik, M.D. University of Cincinnati, Cincinnati, Ohio.

There is controversy regarding the factors which may promote the development or progression of retinopathy in insulin-dependent diabetic (IDD) patients during pregnancy. We hypothesized that pregnant IDD patients with hypertensive disorders (chronic or pregnancy­induced) are at increased risk for developing these specific retinal complications. We studied 99 pregnant IDD patients, who were prospectively followed in our program and underwent standardized fundoscopic examinations each trimester and at three months postpartum by an ophthalmologist. Seventy-six patients were normotensive and 23 had hypertensive disorders. Retinopathy developed or progressed in 17 normotensive patients (22%) and in 10 hypertensive patients (43%). While hypertension was univariately associated with retinopathy (p < 0.05), logistic regression analysis revealed that elevated first trimester glycohemoglobin Al and duration of the diabetic disease were the two significant independent variables associated with development or progression of retinopathy (p < 0.02). We speculate that improving glycemic control preconceptionally and in early pregnancy may reduce the incidence of these complications.

Supported in part by NIH grant HD-11725

SPO Abstracts 281

123 AUTOANTIBODY TESTING IN PREGNANCY. David Star0, Mark Morgan, Dept. of OB/GYN, University of Oklahoma College of Medicine, Oklahoma City, OK

Autoimmune diseases, such as systemic lupus erythematosus (SLE), predominantly afflict reproductive aged women. The clinical course of these diseases are characterized by multisystem exacerbations and remissions. Gravid women presenting with signs and ;ystems of autoimmune disease, such as hypertension and thrombocytopenia, often have autoantibody testing performed. Therefore, the purpose of this study was twofold: 1) determine the frequency of positive autoantibody tests in gravid women in whom tests were performed, and 2) correlate autoantibody test results with maternal and neonatal outcome. The charts of 82 gravid women in whom autoantibody testing was performed were reviewed. Autoantibody tests performed included antinuclear antibodies (mouse kidney and human epithelial cells), anti-DNA antibodies (single and double stranded DNA) and precipitating antibodies (anti-Rho and La). The most common indications for autoantibody testing were hypertension and thrombocytopenia and two patients were known to have SLE. Thirty-nine positive autoantibody results were observed to occur in 29 patients. Although one patient was positive for anti-Rho autoantibody and her fetus had heart block, the remaining positive autoantibody results did not correlate with maternal antepartum complications, mode of delivery, fetal sex, presence of meconium, neonatal complications, apgar scores, or length of maternal or neonatal hospitalization. Based on these data, we believe that autoantibody testing without significant clinical evidence of SLE or other autoimmune diseases does not appear to be efficacious.

124 SERUM GLUCOSE, INSULIN, AND C-PEPTIDE LEVELS IN UNTREATED AND INSULIN TREATED PREGNANT WOMEN WITH GESTATIONAL DIABETES MELLITUS. K. Anthony Shanbou~, Gary R. Thurnau, Vicki MintonX

, Dept. of OB/GYN, Univ. of Oklahoma Coil. of Med., Oklahoma City, OK

Residual B-cell function (as measured by C-peptide excretion and glycemic control) has been evaluated in pregnant diabetics; however, no one has evaluated fasting and post-prandial serum glucose, insulin, and C-peptide levels in untreated and insulin treated pregnant women with gestational diabetes mellitus (GDM). The purpose of this study is to compare fasting and post-prandial serum glucose, insulin, and C-peptide levels in four groups of women: Group I: (n=8) Non-diabetic, non-pregnant women; Group II: (n=7) Non-diabetic, pregnant women in 3rd trimester; Group III: (n=6) Untreated GDM in 3rd trimester; and Group IV: (n=4) Insulin treated GDM in 3rd trimester. All patients in the study were given a standardized breakfast at 0800 consisting of 550 KCalories. Venipunctures were done on all patients at 0700, 0900 and 1000. Blood samples were assayed for glucose, insulin and C-peptide levels from which glucose/insulin, insulin/C­peptide, and glucose/C-peptide ratios were calculated. RESULTS: Compared with those of Group I, mean post-prandial glucose, insulin and C-peptide levels were significantly higher in Group II (as expected). In contrast, the mean 0700 C-peptide level and mean 0900 glucose/C-peptide ratio of Group III were significantly higher than those of Group II. Of interest, all mean C-peptide levels of Group IV were higher than those of Group III. CONCLUSION: The fasting serum C-peptide level and 1 hour post-prandial glucose/C-peptide ratio may identify the need for insulin treatment of GDM.