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Volume 164 ]\;umber 1, Part 2

SUBSTANCE ABUSE SCREENING OF REPRODUCTIVE-AGE WOMEN IN ALABAMA PUBLIC HEALTH CLINICS. J Price, MSN, RNC~, J Hauth, M.D., Division of Maternal-Fetal Medicine, University of Alabama at Birmingham (UAB); S George~, MPH, D Barnette~, ACSW, Alabama Department of Public Health.

During August, 1989, 5010 reproductive-age women had a urine screen for marijuana, cocaine, opiates, amphetamines, and barbit­urates. These patients consisted of 2596 low­risk maternity, 2019 family planning, and 374 DAB high-risk maternity patients. Eleven percent (11%) of state-wide maternity patients had a positive (+) screen for any drugs tested. There were significantly more (+) marijuana screens in the first trimester (lst-16%, 2nd-13%, 3rd-10%) but no difference among trimesters for (+) cocaine screens. We also found: (1) there was no difference among preg­nant and nonpregnant women for (+) cocaine screens (2) there was no difference among urban and rural groups for any of the drugs tested (3) there was no difference among high­or low-risk maternity patients for any drugs tested (4) marijuana screens were increased among white and nonpregnant women, p<.Ol (5) cocaine screens were increased among black and slngle women, p<.Ol (6) more screens were (+) in women over age 20, p<.Ol. These results will be used for program planning for public health pati~nts in Alabama.

COULD THE FASTING PLASMA GLUCOSE BE USED TO SCREEN FOR GESTATIONAL DIABETES? David A Sacks r,lO, Jeffrey S Greenspoon MD, Nick Fothenngham PhDx. Departments of Obstetrics and Gynecology, Kaiser Foundation Hospi­tal, Bellflower, and Cedars-Sinai Medical Center, Los Angeles, California.

A pl asma assay performed one hour after a 50 gram glucose load is the current standard screening test for gestational diabetes (GDM). This test is sensi­tive, specific, acceptable and cost-effective. How­ever, because of its poor reproducibility, it is possible that a single test might miss a substantial proportion of gestational diabetics. The fasting plasma glucose (FPG) is more precise and changes less with advancing gestational age than does a post­glucose screening test (GST). This study was designed to test the hypothesi s that the FPG performs as well as the GST as a screening test for GDM. A GST was used to screen 4561 consecutive patients. A 3 hour glucose tolerance test (GTT) was performed on the 968 patients whose GST result was >135 mg/dl. The FPG component of the GTT was used for data analysis. There were 141 diabetics among the 968 subjects (14.6%). Assuming that these 141 patients represented all the diabetlcs in the patient sample, we constructed receiver operating characteristic curves for the GST and FPG values, respectively. The area under the FPG curve was greater than that under the GST curve (p<O.OOI), suggesting greater discriminatory value of the FPG. Of the 116 patients who had sequen­tlal GST's and FPG's performed twice during the preg­nancy an average of 16 weeks apart, a significant correlation was found for FPG values (r=0.64, p<O.OOI) but not for GST values (r=O.08; p=0.427). We conclude that the fasting plasma glucose may perform better than the GST as a screening test for GD~1. Based on these data, a population-based prospective study seems justified.

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SPO Abstracts 283

CHRONIC GLUE AND PAINT SNIFFING DURING PREGNANCY: A POPULATION AT RISK FOR FETAL AND MATERNAL MORBIDITY Louise Wilkins-Hau~,M.D.,Ph.D.x and Patricia Gabow, M.D. , Denver General Hospital, Denver, Colorado

Toluene aerosolized from glue and paint is a popular method of substance aouse. Although toluene is known to cross the placenta, vapor abuse during pregnancy has received little attention. A retrospective review of 30 pregnancies to 11 chronic abusers revealed poor perinatal outcome and significant maternal morbidity.Fetal complications in common with other substance abuse populations included growth retardation (43%), preterm delivery (40%), abruption (10%) and perinatal demise (10%). Unique to toluene abusers were episodes of maternal renal tubular acidosis and severe hypokalemia (43%), Toluene induced acidosis commonly presented with Rreterm labor, emesis and weakness. Rhabdomyolysis developed in two cases and EKG changes were noted in three instances, Delivery during maternal acidosis was associated w~th fetal acidosis and prolonged neonatal hospitalizations. We conclude that (1) the high rate of growth retardation and preterm labor warrant close antepartum surveillance, (2) distal renal tubular acidosis complicates a sub stantial numb e r of toluene exposed pregnancies, (3) unrecognized acidosis and hypokalemia can lead to maternal morbid~ty especially during the treatment of preterm labor and (4) aelivery during maternal acidosis further compromises these infants.

PREDICTORS OF COCAINE USE AMONG PARTURIENTS: S. MCCalla~ H. Minkoff, J. Feldman~ M. salwen~ G. Valencia~ L. Glass~ SUNY-Health Science Center at Brooklyn, New York

The following study was undertaken to determine if clinical markers would be sensitive (s) and specific (sp) indicators of cocaine use in pregnancy. Eleven hundred eleven parturients were tested for cocaine metabolites with results linked by a code to labor and neonatal outcomes. Cocaine metabolites were present in 11.5%. Predictive values of the most useful indicators follow:

1. No care 51 91 43 93 2. Tobacco 77 85 40 96 3. Admit Use 42 99 84 93 4. 1 and 2 46 97 66 93 In spite of these fairly good predictive values a significant portion of all cocaine users were missed. Conclusion: If it is important to identify all cocaine users, screening all patients for metabolites of the drug will become essential.