,"alum" lli4 !\umber L Part 2

51 0 ALTERATIONS OF CALCIUM AND PHOSPHATE METABOLISM IN PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY. P Ammann" J. Gast ", O. Irion", J.-P. Bonjour", F. Beguin, R. Rizzoli" Division of Clinical Pathophysiology, Department of Medicine, and Department of OB/GYN, University Hospital, GENEVA, Switzerland.

Primary hyperparathyroidism (PHP) is rare during pregnancy and seems to be associated with significant increase of neonatal morbidity and mortality. Whether the well recognized changes in calcium (Ca) and phosphate (Pi) homeostasis occurring in pregnancy might influence the biochemical expression of PHP is not known. We investigated a 30 week pregnant woman with PHP till delivery on the 38th week. The patient displayed increase in protein adjusted plasma Ca (3.23±0.11 mM, x±SD, n-4 determinations, normal range (N): 2.25-2.62), in bone resorption (BR) evaluated by the fasting urinary Ca/creatinine ratio (1.2±O.5 mM/mM, N: 0.1-0.5), in renal tubular reabsorption of Ca (TRCal) (3.28±0.22 mmolll GFR, N:240-2.88), in urinary cAMP excretion (85.1±34.8 nmolll GFR, N: 25.0-46.0) and In intact PTH (14.2±2.7 pM, N:l.0-5.7), and decrease in renal tubular reabsorption of Pi (TmPi) (0.63±0.08 mmolll GFR, N: 0.80-1.30). These a~erations were Identical to those found in 10 non pregnant women wrth PHP (Ca: 2.86±0.14, BR: 0.6±0.4, TRCal: 3.05±0.18, TmPi: 0.65±0.16). The biochemical expression of PHP was also studied after delivery. After parturitIOn, the values remained the same (plasma Ca: 3.09:tO.13, BR: 1.0±0.3, TRCal: 3.40±0.36, cAMP: 52.9±16.6, intact PTH: 11.3±2.5, TmPi: 0.57±0.06, n=4 determinations). Excision of a 1 g parathyroid adenoma on the 13th day after delivery led to normalization of all values (plasma Ca: 2.37±0.06, BR: 0.3±0.2, TRCal: 2.69±0 13, cAMP: 33.3±1.2, intact PTH: 2.7±1.7, TmPi: 1.38±O.19). A slight but asymptomatic hypocalcemia (2.02 mM), occurred in the newborn 72 hours after birth. These resu~s indicate that the changes in BR and ionic renal tubular transports in this case of PHP during pregnancy are similar to those observed in PHP of non pregnant women.

511 TOCOL YTIC THERAPY AND INTRA VENTRICUIAR HEMORRHAGE IN THE NEONATE. Joel Pranikoff,x Rick Helmchen, and Larry Evertson. Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio.

Preterm labor continues to be a major problem in modern obstetrics. The prevention of premature birth often involves the use of tocolytic agents, primarily, the 13-sympathomimetics. These agents freely cross the placenta and have been associated with many fetal cardiovascular complications. We examined the role of IV 13-sympathomimetics in the pathogenesis of periventricular­intraventricular hemorrhage (IVH). A retrospective chart review of 140 mother-infant pairs, s 34 weeks gestation, was performed. The incidence of IVH in the infants exposed to IV j3-sympathomimetics was 37.5% compared to 12.1% in those infants not exposed. Gestational ages and birth weights in the two groups were not significantly different. This study indicates that: 1) IV 13-sympathomimetics may increase the risk of IVH in the neonate, 2) a prospective study is needed to look more carefully at this association, and 3) these drugs should be used only when the risks and benefits are carefully analyzed.

SPO Abstracts 387

512 COCAINE DOES NOT ALTER HUMAN UMBILICAL ARTERIAL TENSION IN RESPONSE TO NOREPINEPHRINE. Mitchell P. Dombrowski, Ruth T. Savoy-Moore', Alice Cheng'. Fetal Alcohol Research Center, Department Ob/Gyn, Wayne State University and Hutzel Hospital, Detroit, MI.

Cocaine prevents synaptic norepinephrine (NE) reuptake. We examined human umbilical artery (HUA) tensions in response to NE plus cocaine ill vitro. Helically cut HUA strip pairs were placed in physiological salt solution and attached to isometric force transducers. Cocaine (10·9M) was present in bath 1 for 30 min prior to, and during, the NE dose response curve; bath 2 received NE only. Tensions (grams) for NE alone and NE plus cocaine are indicated below.

NE Dose (M) NE alone NE + Cocaine (n=l1) (mean ± SE) (mean ± SE)

10.9 .05 ± .03 -.01 ± .01 5xl0·9 .06 ± .03 -.01 ± .02

10·· .11 ± .04 -.02 i .04 5xl0·· .23 i .06 .12 ± .08

10.7 .37 ± .09 .36 ± .07 5xlO·7 .69 i .14 .68 i .10

10'" .66 i .13 .68 i .10

Cocaine from 10.9 to 10·5M did not alter HUA tension alone (p>0.6) nor did cocaine 10·eM affect HUA response to NE (p>0.5). NE increased tension (p<O.OOI). Thus cocaine does not have a direct, nor an indirect, NE-mediated effect on the HUA. Supported by NIAAA 1 P 50 AA 07606.

513 ANTICARDIOLIPIN ANTIBODIES (ACA) AND PREGNANCY Loyola University Medical Center

N Carlson MD, J Gianopoulos MD, R Karlman MD, L Fischer-Holden MS+, A Borkowski+

ACAs were evaluated In 124 patients and the pregnancies reviewed. Testing indication had to include at least one of: ~ 2 unexplainable miscarriages, IUFD, history or current IUGR, abruption, or early onset preeclampsia. Levels were ascertained at pre­pregnancy evaluation or during pregnancy. 51 patients (41%) had positive values ~5 SO) 21 (41%) were positive for IgG, 10.3+/-6.1 (mean+/-SD) SO above the mean; 35 (69%) for IgM, 11.5+/-9.2 SO above the mean, 5 (10%) for both. No patient had lupus anti­coagulant 18 (35%) were treated with 81 mg/d aspirin (ASA) , 28 (55%) with ASA and prednisone, 28+/-18 mg/d, and 5 (10%) were untreated (4 had levels drawn just prior to delivery). One patient, treated with ASA and prednisone also received heparin for a PE this pregnancy. Duration of treatment in both groups was similar. Maternal age, gravidity, parity were similar In ali groups Pregnancy and neonatal outcome and complications are summarized below.

Trtmt None (5) ASA (ID P+ASA (24) Lvborn 5 (100%) 16 (94%) 20 (85%) Abrupt 1 (20%) 2 (12%) 2 (8%) Preecl 3 (60%) 2 (12%) 4 (17%) IUGA 0 1 (6%) 2 (8%)

Babies 6 19 24 GA(wk) 33+33 37 +8.4 35 2+3.0 BW(gm) 1795±629 3208±876 2706±849 NICU adm 3 (50%) 1 (6%) 9 (38%) IVH 19r1 (16%) 0 1913 (4%) NND 0 0 2 (8%)

ACA can adversely affect pregnancy outcome. Treatment with aspirin and/or aspirin and prednisone may improve outcome.