apwma

po

U

I

am

(tgai

1a

bnattoa

rbnp

C

s

E

H

boptpaga

Ulwpcpw

bptbd

mt

I

cscc

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