1
91.7% (p0.48). 68.9% of subjects preferred C/I, 24.3% preferred T/V, and 6.8% had no preference. The p value was 0.001 between CI and T/V. C/I was superior to T/V in all other areas of satisfaction surveyed. CONCLUSIONS: When monitoring fingersticks for management of di- abetes in pregnancy, C/I reporting improved compliance when com- pared to T/V reporting. When the novel C/I was used first, compliance was improved for both C/I and T/V indicating that the C/I stimulated more interest in diabetes management. C/I was superior to T/V across all aspects of satisfaction surveyed. Compliance (Fasting, 2hr post breakfast, lunch, & dinner) C/I when C/I first 91.7% .......................................................................................................................................................................................... T/V when C/I first 87.6% .......................................................................................................................................................................................... C/I when T/V first 86.4% .......................................................................................................................................................................................... T/V when T/V first 87.6% .......................................................................................................................................................................................... 269 Perinatal outcome in relation to birth weight percentile and ponderal index in 3530 offspring of type 1 diabetic mothers (T1DM) Martina Persson 1 , Dharmintra Pasupathy 2 , Ulf Hanson 3 , Mikael Norman 1 1 Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, 2 Kings College London, London, 3 Department of Woman and Child Health, Uppsala University, Uppsala OBJECTIVE: The aim of this study was to compare the prediction of adverse pregnancy outcome by birth weight percentile and by abnor- mal body composition in offspring of T1DM. STUDY DESIGN: Population-based cohort of 3530 singleton infants (1782 boys) born to T1DM in Sweden between1998-2007 with a ges- tational age of 32-42 weeks (fetal abnormality,stillbirths and small for gestational age infants excluded). Neonatal macrosomia was defined as BW90 th percentile and abnormal body composition as ponderal index (PI - BW in grams/length in cm 3 ) 90 th percentile for sex and gestational age in a non-diabetic reference population. Odds ratios (OR) for adverse perinatal outcomes were estimated for four birth size categories, based on BW and PI percentiles: reference category 1) BW 10-90 th and PI90th category 2) BW 90 th and PI90th 3) BW 10-90th and PI90 th and 4) BW90 th and PI90 th .The Or’s were adjusted for between group differences in gestational age. RESULTS: The risk of CS appeared to be more related to abnormal body composition than high BW percentile whereas the risk of peri- neal tear,delivery trauma and respiratory disorders was closer associ- ated with high BW percentile irrespective of PI. The risk of fetal dis- tress was reduced in cat 2 and 4, probably due the higher CS rate in those categories.There was no significant difference in the incidence of neonatal death, neonatal hypoglycaemia, seizures, low Apgar score and hypoxic ischemic encephalopathy between the groups. CONCLUSIONS: High BW percentile in T1DM offspring increases the risk of perinatal complications. The risk of CS is related to abnormal body composition rather than high BW percentile whereas the risk of neonatal outcomes appears to be more closely related to high BW percentile, irrespective of body composition. Cat 1 Normal BW and PI (n1534) BW md:3471g Cat 2 High BW and normal PI (n945) BW md:4210g Cat 3 Normal BW and high PI (n258) BW md:3632.5g Cat 4 High BW and PI (n793) BW md:4390g Cesarean section(CS) 1.0 1.35 (1.14-1.60) 1.39 (1.06-1.82) 2.40 (2.00-2.88) ........................................................................................................................................................................................................... Perineal tear* 1.0 2.94 (1.67-5.18) 2.12 (0.88-5.10) 2.67 (1.38-5.15) ........................................................................................................................................................................................................... Delivery trauma** 1.0 3.95 (2.26-6.88) 1.03 (0.30-3.51) 4.03 (2.16-7.52) ........................................................................................................................................................................................................... Fetal distress 1.0 0.80 (0.63-1.00) 0.77 (0.53-1.13) 0.49 (0.37-0.64) ........................................................................................................................................................................................................... TTN or RDS 1.0 1.56 (1.02-2.40) 1.07 (0.49-2.34) 1.79 (1.15-2.78) ........................................................................................................................................................................................................... Hyperbilirubinemia 1.0 1.45 (1.00-2.10) 1.39 (0.75-2.60) 1.66 (1.13-2.44) ........................................................................................................................................................................................................... *3 rd or 4 th perineal tear; ** Erbs palsy and/or clavicle fracture in vaginally delivered infants. 270 Correlation of fetal Dopplers with placental stereology in pre-gestational diabetic pregnancy Mary Higgins 1 , John Bannigan 2 , Patrick Felle 2 , Eoghan Mooney 3 , Fionnuala McAuliffe 1 1 UCD School of Medicine and Medical Science, National Maternity Hospital, Holles St, Dublin, 2 Anatomy, Health Sciences, University College Dublin, Dublin, 3 Pathology, National Maternity Hospital, Dublin OBJECTIVE: Diabetes Mellitus affects less than 1% of all pregnancies but is a significant cause of neonatal mortality and morbidity. The role of ultrasound assessment in the prediction of morbidity of diabetic pregnancy remains controversial. Ultrasound can assess fetal circula- tion; umbilical artery (UAPI), middle cerebral artery (MCAPI) and peak systolic velocity of the middle cerebral artery (MCAPSV). The aim of this study was to correlate fetal circulation and size in pre- gestational diabetic (PGDM) pregnancy with placental structure as assessed by stereology. STUDY DESIGN: This is a prospective study where third trimester UAPI, MCA PI, MCA PSV and fetal growth was measured in the third tri- mester in PGDM pregnancy (n19). The placenta was collected after delivery and sampled in a systematic random fashion to obtain a series of images for analysis. Stereological analysis was performed using a computerised stereology programme (Image Pro 6.2; Media Cyber- netics, Inc, Silver Spring MD) to assess volume and length of placental components (volume, length and surface area of terminal villi, inter- mediate villi and capillaries). RESULTS: There was no statistically significant association between UAPI, MCA PI and MCA PSV and placental component volume or lengths. Surface area of intermediate villi was statistically correlated with UAPI at both 30 (r- 0.5, p0.03) and 36 weeks (r0.56 p0.01) gestation. In addition intermediate villi surface area signifi- cantly correlated with both EFW at 30 weeks gestation (r0.5, p0.03), 36 weeks gestation (r0.469, p0.049) and with birth weight r0.5, p0.03). CONCLUSIONS: Surface area of intermediate villi is correlated with um- bilical artery PI, fetal growth and birth weight. Whilst it is known that placental size correlates with birth weight, there is a paucity of data on the inter-relationship between individual placental components and birth weight. These novel findings suggest the importance of interme- diate villi in determining fetal growth. 271 Trends in fetal lung maturity of diabetic mothers at 34 weeks gestation and above at the Regional Medical Center, Memphis TN Miriah Denbo 1 , Norman Meyer 1 , Giancarlo Mari 2 1 University of Tennessee Health Science Center, Memphis, TN, 2 University of Tennessee Health Science Center, Tennessee Institute of Fetal-Maternal and Infant Health, Memphis, TN OBJECTIVE: Perinatal mortality is increased in pregnancies compli- cated by insulin requiring diabetes with an increase in the rate of stillbirth. Although the incidence of intrauterine demise may be de- creased with early delivery, this approach is associated with an in- crease in the complications of prematurity. Amniocentesis to docu- ment fetal lung maturity (FLM) prior to delivery may decrease the rate Poster Session II Diabetes, Labor, Ultrasound-Imaging www.AJOG.org S114 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011

270: Correlation of fetal Dopplers with placental stereology in pre-gestational diabetic pregnancy

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Page 1: 270: Correlation of fetal Dopplers with placental stereology in pre-gestational diabetic pregnancy

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Poster Session II Diabetes, Labor, Ultrasound-Imaging www.AJOG.org

91.7% (p�0.48). 68.9% of subjects preferred C/I, 24.3% preferredT/V, and 6.8% had no preference. The p value was �0.001 between CIand T/V. C/I was superior to T/V in all other areas of satisfactionsurveyed.CONCLUSIONS: When monitoring fingersticks for management of di-betes in pregnancy, C/I reporting improved compliance when com-ared to T/V reporting. When the novel C/I was used first, complianceas improved for both C/I and T/V indicating that the C/I stimulatedore interest in diabetes management. C/I was superior to T/V across

ll aspects of satisfaction surveyed.

Compliance (Fasting, 2hr postbreakfast, lunch, & dinner)

C/I when C/I first 91.7%..........................................................................................................................................................................................

T/V when C/I first 87.6%..........................................................................................................................................................................................

C/I when T/V first 86.4%..........................................................................................................................................................................................

T/V when T/V first 87.6%..........................................................................................................................................................................................

269 Perinatal outcome in relation to birth weightercentile and ponderal index in 3530 offspringf type 1 diabetic mothers (T1DM)

Martina Persson1, Dharmintra Pasupathy2,lf Hanson3, Mikael Norman1

1Department of Clinical Science, Intervention and Technology, Karolinskanstitutet, Stockholm, 2Kings College London, London, 3Department

of Woman and Child Health, Uppsala University, UppsalaOBJECTIVE: The aim of this study was to compare the prediction ofdverse pregnancy outcome by birth weight percentile and by abnor-al body composition in offspring of T1DM.

STUDY DESIGN: Population-based cohort of 3530 singleton infants1782 boys) born to T1DM in Sweden between1998-2007 with a ges-ational age of 32-42 weeks (fetal abnormality,stillbirths and small forestational age infants excluded). Neonatal macrosomia was defineds BW�90th percentile and abnormal body composition as ponderalndex (PI - BW in grams/length in cm3) �90th percentile for sex and

gestational age in a non-diabetic reference population. Odds ratios(OR) for adverse perinatal outcomes were estimated for four birth sizecategories, based on BW and PI percentiles: reference category 1) BW10-90th and PI�90th category 2) BW �90th and PI�90th 3) BW

0-90th and PI�90th and 4) BW�90th and PI�90th.The Or’s weredjusted for between group differences in gestational age.

RESULTS: The risk of CS appeared to be more related to abnormalody composition than high BW percentile whereas the risk of peri-eal tear,delivery trauma and respiratory disorders was closer associ-ted with high BW percentile irrespective of PI. The risk of fetal dis-ress was reduced in cat 2 and 4, probably due the higher CS rate inhose categories.There was no significant difference in the incidencef neonatal death, neonatal hypoglycaemia, seizures, low Apgar scorend hypoxic ischemic encephalopathy between the groups.

CONCLUSIONS: High BW percentile in T1DM offspring increases theisk of perinatal complications. The risk of CS is related to abnormalody composition rather than high BW percentile whereas the risk ofeonatal outcomes appears to be more closely related to high BWercentile, irrespective of body composition.

m

S114 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

Cat 1Normal BWand PI(n�1534)BW md:3471g

Cat 2High BWand normal PI(n�945)BW md:4210g

Cat 3Normal BWand high PI(n�258)BW md:3632.5g

Cat 4High BWand PI(n�793)BW md:4390g

esarean section(CS) 1.0 1.35 (1.14-1.60) 1.39 (1.06-1.82) 2.40 (2.00-2.88)...........................................................................................................................................................................................................Perineal tear* 1.0 2.94 (1.67-5.18) 2.12 (0.88-5.10) 2.67 (1.38-5.15)...........................................................................................................................................................................................................Delivery trauma** 1.0 3.95 (2.26-6.88) 1.03 (0.30-3.51) 4.03 (2.16-7.52)...........................................................................................................................................................................................................Fetal distress 1.0 0.80 (0.63-1.00) 0.77 (0.53-1.13) 0.49 (0.37-0.64)...........................................................................................................................................................................................................TTN or RDS 1.0 1.56 (1.02-2.40) 1.07 (0.49-2.34) 1.79 (1.15-2.78)...........................................................................................................................................................................................................Hyperbilirubinemia 1.0 1.45 (1.00-2.10) 1.39 (0.75-2.60) 1.66 (1.13-2.44)...........................................................................................................................................................................................................

* 3rd or 4th perineal tear; ** Erbs palsy and/or clavicle fracture in vaginally delivered infants.

270 Correlation of fetal Dopplers with placentaltereology in pre-gestational diabetic pregnancy

Mary Higgins1, John Bannigan2, Patrick Felle2,oghan Mooney3, Fionnuala McAuliffe1

1UCD School of Medicine and Medical Science, National Maternity Hospital,olles St, Dublin, 2Anatomy, Health Sciences, University College Dublin,

Dublin, 3Pathology, National Maternity Hospital, DublinOBJECTIVE: Diabetes Mellitus affects less than 1% of all pregnancies

ut is a significant cause of neonatal mortality and morbidity. The rolef ultrasound assessment in the prediction of morbidity of diabeticregnancy remains controversial. Ultrasound can assess fetal circula-ion; umbilical artery (UAPI), middle cerebral artery (MCAPI) andeak systolic velocity of the middle cerebral artery (MCAPSV). Theim of this study was to correlate fetal circulation and size in pre-estational diabetic (PGDM) pregnancy with placental structure asssessed by stereology.

STUDY DESIGN: This is a prospective study where third trimester UAPI,MCA PI, MCA PSV and fetal growth was measured in the third tri-mester in PGDM pregnancy (n�19). The placenta was collected afterdelivery and sampled in a systematic random fashion to obtain a seriesof images for analysis. Stereological analysis was performed using acomputerised stereology programme (Image Pro 6.2; Media Cyber-netics, Inc, Silver Spring MD) to assess volume and length of placentalcomponents (volume, length and surface area of terminal villi, inter-mediate villi and capillaries).RESULTS: There was no statistically significant association between

API, MCA PI and MCA PSV and placental component volume orengths. Surface area of intermediate villi was statistically correlatedith UAPI at both 30 (r- �0.5, p�0.03) and 36 weeks (r��0.56�0.01) gestation. In addition intermediate villi surface area signifi-antly correlated with both EFW at 30 weeks gestation (r�0.5,�0.03), 36 weeks gestation (r�0.469, p�0.049) and with birtheight r�0.5, p�0.03).

CONCLUSIONS: Surface area of intermediate villi is correlated with um-ilical artery PI, fetal growth and birth weight. Whilst it is known thatlacental size correlates with birth weight, there is a paucity of data onhe inter-relationship between individual placental components andirth weight. These novel findings suggest the importance of interme-iate villi in determining fetal growth.

271 Trends in fetal lung maturity of diabeticothers at 34 weeks gestation and above at

he Regional Medical Center, Memphis TNMiriah Denbo1, Norman Meyer1, Giancarlo Mari2

1University of Tennessee Health Science Center, Memphis, TN,2University of Tennessee Health Science Center, Tennesseenstitute of Fetal-Maternal and Infant Health, Memphis, TN

OBJECTIVE: Perinatal mortality is increased in pregnancies compli-ated by insulin requiring diabetes with an increase in the rate oftillbirth. Although the incidence of intrauterine demise may be de-reased with early delivery, this approach is associated with an in-rease in the complications of prematurity. Amniocentesis to docu-

ent fetal lung maturity (FLM) prior to delivery may decrease the rate

011