Methamphetamine use during pregnancy

277 MAGNESIUM SULFATE INHIBITS INFLAMMATORY RESPONSES IN HUMANUMBILICAL VEIN ENDOTHELIAL CELLS (HUVECS) BURTON ROCHELSON1,OONAGH DOWLING2, CHRISTINE N. METZ2, JEANNE WOODS1, 1North Shore Uni-versity Hospital, Division of Maternal-Fetal Medicine, Manhasset, NewYork, 2Institute for Medical Research at North Shore-LIJ, Center for PatientOriented Research, Manhasset, New York

OBJECTIVE: Although it has been used for decades for the treatment ofpremature labor and seizure prophylaxis in preeclampsia, the exact mechanismof action of magnesium sulfate (MgSO4) has not been definitively elucidated.Aberrant pro-inflammatory cytokine production has been implicated in theetiology of each of these disorders. Our objective was to determine the effect ofMgSO4 on human umbilical vein endothelial cell (HuVEC) inflammatoryresponses by examining its effect on basal and stimulated inflammatorycytokine production and cell adhesion molecule expression in vitro.

STUDY DESIGN: Human umbilical vein endothelial cells (HuVECs) wereisolated from anonymous umbilical cords using collagenase. Confluent HuVECmonolayers (in M199 media containing 10%FBS) were treated with MgSO4(1-10 mM) alone or MgSO4 (1-10 mM) followed by LPS (1 ug/ml) 0.5 hr later.After an overnight incubation, (a) cell culture supernatants were collected forIL-8 determination by ELISA and (b) cellular ICAM-1 expression was evalu-ated using a cell-based ELISA method. Statistical significance was determinedbyANOVA followed byTukey post hoc analysis tomake pairwise comparisons.

RESULTS: Under basal conditions, MgSO4 had no effect on IL-8 produc-tion or ICAM-1 expression by HuVEC cultures. We observed that treatmentof HuVECs with MgSO4 (2.5 mM-10 mM) prior to LPS stimulation inhibitedIL-8 production, in a dose-dependent manner (25-50% inhibition, p!0.05).Similarly, MgSO4 (2.5-10 mM) treatment suppressed ICAM-1 expression byLPS (25-40% inhibition, p!0.05). MgSO4 was more potent than dexameth-asone alone and the combination of dexamethasone C MgSO4 was notadditive. MgSO4 was not cytotoxic at the concentrations used.

CONCLUSION: MgSO4 inhibits the LPS-induced IL-8 production andICAM-1 expression by HuVECs. . This suppression of inflammatory cytokineproduction and expression of ICAM-1 by the endothelium may help to explainthe efficacy of magnesium sulfate in preeclampsia and preterm labor. Ourongoing studies focus on investigating the mechanism(s) of action.

278 WITHDRAWN

279 METHAMPHETAMINE USE DURING PREGNANCY PATRICIA SCOTT1, MARY FLEMING1,KELLY BENNETT1, CORNELIA GRAVES1, 1Vanderbilt University, Obstetrics/Gynecology, Nashville, Tennessee

OBJECTIVE: Methamphetamine is the fastest growing illicit drug in theUnited States. It is a powerfully addictive stimulant and is produced easily inhome laboratories. Methamphetamine use has been associated with adverseevents including myocardial infarction and stroke. Outcomes of methamphet-amine use during pregnancy are not described in the literature. The purposeof this study is to determine the outcomes in pregnancies exposed tometamphetamine.

STUDY DESIGN: A retrospective chart review of all pregnancies associatedwith substance abuse from 1998 until present at our tertiary care center wasundertaken. Pregnant patients with presumptive positive urine drug screen formethamphetamine and metabolites were included. Data were analyzed foradverse maternal and fetal outcomes, including hypertensive complications,prematurity, NICU admissions and maternal or fetal death.

RESULTS: Study search criteria was met by 675 patients. Thirty-two recordswere identified as presumptive positive for methamphetamine and/or metab-olites. Results were divided into maternal and neonatal complications.Maternal complications comprised 68.75% (22/32) of the total. Preterm laboraffected 21.9% (7/32). Hypertensive complications affected 25% (8/32) ofpatients: preeclampsia 15.6% (5/32), post-partum preeclampsia 6.25% (2/32),and one hypertensive emergency (1/32). Antepartum hemorrhage complicated12.5% (4/32). Two maternal deaths occurred in our cohort. Total numberof births was 27, with neonatal complications occurring in 70.4% (8/27).Prematurity complicated 51.9% (14/27). Admission to NICU occurred in48.1% (13/37) with 84.6% (11/13) accounting for preterm neonates. Threeneonatal deaths occurred.

CONCLUSION:With the increase of methamphetamine use, its effects duringpregnancy are more relevant. This study suggests methamphetamine useduring pregnancy is associated with significant maternal and fetal morbidity.

280 MATERNAL OUTCOMES OF PREGNANT WOMEN WITH ASTHMA EXACERBATIONREQUIRING INTENSIVE MANAGEMENT IN A CRITICAL CARE SETTINGAMMAR SHAMMAA1, JERRIE REFUERZO1, SEAN BLACKWELL1, YORAM SOROKIN2,1Wayne State University, Obstetrics and Gynecology, Detroit, Michigan,2Wayne State University, Ob/Gyn/Maternal Fetal Med, Detroit, Michigan

OBJECTIVE: The purpose of this study is to determine maternal outcomes ofpregnant women with severe acute exacerbation of asthma requiring intensivematernal management.

STUDY DESIGN: A retrospective chart review was conducted of admissionsto a maternal special care unit (MSCU) due to a severe asthma exacerbationduring pregnancy from January 2002 to December 2003. All pregnant womenwith hypoxia, respiratory distress and/or persistent severe exacerbation ofasthma are routinely admitted to the MSCU, a specialized unit that providesintensive maternal management in a critical care setting. Maternal demo-graphics, asthmatic history and clinical characteristics were collected. Fur-thermore, the hospital course of women with a concomitant diagnosis ofpneumonia was compared to those without pneumonia.

RESULTS: Of the 1216 admisssions to the MSCU, 2.8% (n=34) were forsevere asthma exacerbation. Maternal demographics are as follows: age30.3 G 7.9 years, African American 94.1%, gestational age 27.8 G 8.6 weeks,BMI 22.8 G 19.3 kg/m2 and smoking 38.2%. Many women had an asthmatichistory prior to the onset of pregnancy with 64.7% reporting prior steroid useand 26.5% prior intubation. In the current pregnancy, 44.1% reported recentsteroid use and 8.8% were recently intubated. There were 11 admissions(32.4%) with a concomitant diagnosis of pneumonia. These women displayeda longer length of oxygen requirement (5.5 G 4.8 vs 3.2 G 5.1 days, p=0.060),intravenous steroid therapy (4.6 G 4.8 vs. 1.9 G 1.8 days, p=0.201) and totalhospital days (8.3G 6.2 vs. 4.8 G 5.2, p=0.071) compared to women withoutpneumonia. They also had a significantly longer length of time in a critical caresetting (5.5 G 4.9 vs. 1.9 G 1.1 days, p=0.021).

CONCLUSION: Women requiring a critical care setting for the managementof severe asthma exacerbation during pregnancy often have a significantasthmatic history. Prolonged hospital courses are to be expected especially inthose women with concomitant pneumonia.

SMFM Abstracts S87