384

385

382 spa Abstracts

NORMALISATION OF GLUCOSE TOLERANCE IN ADULT OFFSPRING OF DIABETIC PREGNANT RATS BY ISLET TRANSPLANTATION IN THE MOTHER. L. Aerts*, F.A. Van Assche, Department of Obstetrics and Gynecoloqy, University of Leuven, Belgium. Our previous work clearly shows that streptozotocin-induced diabetes in the pregnant rat has long-term consequences for the offspring. This effect is not of genetic origin, but is due to metabolic adaptations induced in the fetus by the diabetic intra-uterine milieu. In the adult offspring of mildly diabetic mothers the insulin-secreting B-cells are affected ; in the adul t offspring of severely diabetic mothers both insulin secretion and peripheral insulin-resistance are involved. A definite cDnclusion can be made by normalizing the diabetic state during pregnancy using islet transplantation. Islets were obtained froll normal neonatal wi stars after pancreatic digestion with collagenase. Severely diabetic rats received an inj ection of 2000 islets into the portal vein at day 15 of gestation, sham-transplanted diabetic animals received the solution medium only~ Glycemia was normalized in the transplanted mothers from the day after transplantation and throughout further gestation and lactation. At weaning (age 20 days) the weight of the pups from transplanted mothers ",as normal while it was seriously decreased in the sham group (32 ± 2 versus 18 ge ± 1e5), as it was in the previous untreated severely diabetic group. In the adult offspring of transplanted mothers, insulin and glucose levels during glucose infusion were normal, however plasma insulin levels were increased in the offspring of sham-transplanted mothers (87 ± 14 uU/ml versus 187 ± 21~U/ml) after a 3 hour glucose infusione The values of the sham treated group were identical as previously shown in the offspring of untreated diabetic mothers.

PLASMA PROTEINS AII0 NUTRITIONAL STATUS IN PREG/IAIICY JE Maher', Rl Goldenberg, T Tamura', SP Cl iver', HJ Hoffman'

University of Alabama Hospitals, Birmingham, Alabama Albumin (Al). prealbumin (PA). and retinol binding protein

(RBP) are used as long, medium and short-term markers for protein nutriture. Their serum half lives in the non-pregnant state are 18, 2, and 0.5 days, respectively. We measured the proteins at 18 and 30 weeks gestation and correlated the levels with birthweight and fetal growth retardation (FGR). We also assessed these protein levels in relation to maternal age, race, infant sex and various measures of nutrition status such as hematocrit, height, pre-pregnancy weight, body mass index (BM!) , lean body mass, and weight gain. Serum samples were obtained from 289 indigent multiparous women, 29% of whom gave birth to a newborn with FGR. None of the protein levels correlated with FGR. Al levels correlated inversely with birthweight at 18 weeks gestation (p=0.05). but not at 30 weeks and neither of the other protein levels correlated with birthweight. At 18 and 30 weeks, there was an inverse association between AL and both pre-pregnancy weight and BMI (p<.OI). but not with maternal weight gain during pregnancy. AL 1 eve 1 s were not related to hei ght or 1 ean body mass. AL levels correlated positively with PA (p<.OOOI) and RBP (p=.OOI) at both 18 and 30 weeks. Hematocrit, infant sex, age, and race did not correlate with serum AL. PA, a protein which migrates during electrophoresis in front of AL but is otherwise not related, also correlated (p<.OI) with pre-pregnancy weight and BMI at 18 weeks but not with any other factor. PA and RBP levels were highly correlated (p<.OOOJ) since they are secreted in association with one another from the 1 iver. RBP and AL levels decreased from 18 to 30 weeks, but for each protein, there was a positive correlation between the 18 and 30 week values (p<.OOI). RBP did not correlate with any of the factors studied except maternal weight gain (p<.03). During pregnancy, plasma protein concentrations are regulated by complex and incompletely understood factors. Extrapol ati ng assumpti ons of nutritional status based upon normal nonpregnant levels of these proteins may not be val id for predicting nutritional status in pregnancy.

386

387

January 1992 Am J Obstet Gynecol

DOES THE PRESENCE OF TRACE PHOSPHATIDYL GLYCEROL (PG) INDICATE NEONATAL LUNG MATURITY? Audrey Gassman,x Robert J. Stiller, Roberta H. de Regt Dept. Ob/Gyn, Bridgeport Hospital, Bridgeport, CT

The presence of trace PG obtained on amniocentesis is usually an indication for further testing (Lecithin/Sphingo­myelin-L/S). We questioned whether trace (tr) PG in any specific patient indicates lung maturity. 58 nondiabetic patients who underwent amniocentesis from August 1989 to March 1991, delivered within 72 hours of the test, and had L/S analysis were included. Lung maturity was examined by clinical diagnosis and by L/S >/= 2. All patients were < 36 weeks. 8 infants (14%) developed respiratory distress, 5 developed transient tachypnea (overall incidence 24%). 3/11 with L/S >/=2 required oxygen >6 hrs in NBICU (33,33,35 wks). The presence of tr PG predicted mature L/S in 76% (19/25) of patients over 34 wks, but only 52% (17/33) of patients under 34 wks. Conclusion: Tr PG is not a good predictor of pulmonary maturity regardless of gestational age.

THE EFFECT OF MATERNAL INTRAVENOUS GLUCOSE ADMINISTRATION ON FETAL ACTIVITY. .I2f......EI..I, RB Newman, SL Strammx. Medical University of South Carolina, Charleston, South Carolina.

Fetal hyperglycemia has been shown to cause marked stimulation of the fetal metabolic state, resulting in increased oxygen consumption. Bocking, et.al.demonstrated increased fetal breathing movements but no change in gross body movements after intra· venous glucose injection (AJOG 1982; 142: 606·611). Others have suggested that increased fetal activity may play a role in this in· creased oxidative metabolism. The following study was designed to prospectively evaluate fetal activity during maternal intravenous glucose tolerance testing (IVGTI). Fourteen women, 30.7±.3.0 weeks gestation, were evaluated continuously for fetal activity wHh a doppler fetal activity monitor (Toitu Model MT·320).Baseline monitoring began 10 minutes before a fasting blood sugar was obtained. A 25 g load of 50% dextrose was administered and maternal plasma glucose levels were drawn at IS, 30, 45 and 60 minutes via an in·dwelling venous catheter. Six control patients, 29.8±,4.8 weeks gestation, were continuously monitored and corresponding plasma glucose levels drawn. However, controls did not receive intravenous dextrose. The plasma glucose levels remained stable in the control group and the corresponding fetal activHy was random. Fetal activity in the IVGTI group increased over time and was best characterized by a polynomial regression curve (y- 16.1 + 0.6X •. 004X2; p _ .0001). The increase in fetal activity in the IVGTI group corresponded to the initial rise in maternal plasma glucose. levels. Glucose is the principle source of energy for the fetus and crosses the placenta rapidly via facilHated diffusion. Fetal glucose levels correlate well wHh maternal plasma glucose (100 mg/dl maternal concentration _ 80 mg/dl fetal concentration). This study confirms that increased fetal activity is a likely consequence of hyperglycemia, suggesting an association between fetal metabolic state and activHy.