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Volume 166 Number 1, Part 2

ELEVATED MSAFP, PLACENTAL ABNORMALITIES, AND PRETERM DELIVERY. MA Williams, x DE Hickok, R Zingheim,x DA Luthy, J Kimmelman,x DA Nyberg,X BS Mahony,X Swedish Hosp. Med. Ctr. and University of Washington, Seattle WA

Unexplained elevated MSAFP in the midtri­mester is associated with placental abnor­malities and adverse pregnancy outcomes. We assessed the association between unexplained elevated MSAFP and placental abnormalities in relation to infant outcomes in a hospital­based cohort study. Women with elevated MSAFP (N=188) had 4 times the risk of deliv­ering a preterm infant than women with normal MSAFP (N=202) (95% CI 2.1-8.0). GROUPS N % Pretenn RR (95 %Cn Nonnal MSAFP, Nonnal placenta 184 4.9 1.0 Elevated MSAFP only 149 17.5 3.6 (1.7-7.4) Elevated MSAFP. Abnonnal placenta 33 33.3 6.8 (3.1-15.2) Women with both elevated MSAFP and abnormal placental findings were 6.8 times more likely to deliver a preterm infant than women with normal MSAFP levels and sonograms (95%CI 3.1-15.2). Elevated MSAFP was associated with a shortening of mean gestation length by 1.4 weeks (95%CI 0.6-2.0). A joint history of elevated MSAFP and placental abnormalities was associated with a greater decrease in the mean gestation by 2.8 weeks (95%CI 1.8-3.9). These findings suggest that elevated MSAFP and placental abnormalities are associated with particularly poor outcome. Careful examination for placental abnormalities should be a part of the evaluation of eleva­ted MSAFP.

ALPHAFETOPROTEIN IN DIABETIC PREGNANCY-A REASSESSMENT. Tessie Tharakan',Laxmi Baxi,Douglas Kramer ,Rosamond AndersonI,College of Physicians & Surgeons .Columbia University &. Columbia Presbyterian Medical Center,New York,NY

We correlated glycosylated hemoglobin (HbAI) with Maternal Serum Alphafetoprotein (MSAFP) corrected for gestational age,race and maternal weight in 90, and amniotic fluid AFP (AFAFP) in 30, diabetic pregnancies.

Patient Time of HbAl mess. n Corr.Coef P Groups HbAl:MSAFP

1 in first 12 wks 22 0.06 ns

2 within 0-6 wlcs. before 42 0.11 ns MSAFP

3 within 6 wlcs after MSAFP 34 O.IS ns

There was no reduction in M~Al't' with Increasmg HbAl values. t ven in patients with HbAI exceeding 9 gm % (n =9) mean MSAFP was 0.S4MOM(SD.;t, 0.29) as compared to 0.S5MOM(SD±.0.23) in those with HbAI from 5 to 8.9 gm%. It has been hypothesised that poor glycemic control may lead to decreased production of AFP by the yolk sac and lor the fetal liver. If so we would expect decreased AFAFP. We measured AFAFP in 30 pregnancies with HbAI from 4.5 to 16% early in pregnancy, and under 7.5% (except 2 patients) at the time of amniocentesis. AFAFP values even in patients with HbAI ~9%(n=3) were within normal limits. Thu8,given these limited data, it appears that degree of control of blood sugar had no influence on fetal AFP production as indicated by AFAFP levels. If the levels of MSAFP in patients with poor glycemic control are low,this i. probably not due to decreased fetal AFP production, but may perhaps be due to increased glycosylation of this protein causing increased catabolism. In conclusion, in this series of pregnancies with fairly well controlleddiabetes,weobservednormal values of AFAFP and MSAFP(mean 0.84 MOM) even when HbAI exceeded 9%.

spa Abstracts 353

274 KARYOTYPE ANOMALIES IN FETUSES WITH URINARY TRACT ANOMALIES. S Sutherland', I...lwM, B Goodwin', J Moore', J '>'kstman', M Motley', E Diss', M Landon. R O'Shaughnessy, R Reiss, and S Gabbe. The Ohio State University Department of Obstetrics & Gynecology, and The Departments of Pediatrics and Cytogenetics Laboratory, Children's Hospital, Columbus. OH

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The prevalence of abnormal karyotypes among fetuses with ultrasonographically detected urinary tract abnormalities is reported to range from I to 28%. The data available to guide clinical care is remarkably limited, however. We reviewed the clinical and ultrasound findings from 60 pregnancies in which a fetal urinary tract anomaly was detected antenatally. Among 33 in whom prc- or postnatal karyotype analysis was performed, there were five (15%) fetuses with abnormal karyotypes. two of whom had no extrarenal anomalies Seen with ultrasound. Tcn of 16 with uni- or bilateral cystic kidneys had a karyotype performed, and two had an abnormal karyotype: A fetus with trisomy 18 had oligohydramnios. a unilateral cystic lcidney, and IUGR, and died in utero. One with 46, XX del (11)(q24.2) had absent amniotic fluid, bilateral renal cysts, and was aborted. Eight others with unilateral (6) or bilateral (2) cystic kidneys had normal karyotypes. Eight cases of megacystis were studied, and three of seven (43%) fetuses tested had abnormal karyotypes: one with a 46. XY/47,XXY karyotype and absent amniotic fluid was electively aborted; another with a cystic hygroma, mcgacyslis, and normal fluid had an unbalanced translocation (46 XV. -12. +der(12) t(4;12)(q28;pI3.3»); a third with a balanced translocation [46,X,t(X:22)(q26;qll.l)matl and oligohydramnios died in the neonatal period of pulmonary hypoplasia. Eleven of 19 fetuses (9 of 13 bilateral and 2 of 6 unilateral) with hydronephrosis had a karyotype done; all were normal. Eight of 17 with renal agenesis or dysplasia had studies done, and all were normal. Women presenting with a fetal renal anomaly should be offered antenatal chromosome studies.

SECOND TRIMESTER MSAFP IN INSULIN DEPENDENT DIABETICS. Sunder;i S, M.D., Macri J'N, Ph.D. x SUNY-Health Science Center at Syracuse, NY, NTD Labs at Carle Place, NY.

Attention has been drawn to the differing concentrations of maternal serum alpha-fetoprotein (HSAFP) in patients with insulin-dependent diabetes mellitus as compared to patients without this disease. We have evaluated this question in 132 insulin-dependent diabetic pregnancies. Our study confirms earlier findings that HSAFP concentrations in pregnant diabetic women are lower than non-diabetic women. However, our study fails to confirm earlier estimates of a 40% reduction. Our data indicates that the MSAFP concentration of pregnant insulin-dependent diabetics results in a 161 redUction compared to that observed in non-diabetic pregnant women.

It has been suggested that there is an inverse correlation between MSAFP and the degree of diabetic control during pregnancy as monitored by glycosylated hemoglObin. This has led some to recommend adjustment in MSAFP concentration in women whose diabetes has not been well controlled. Conversely, no correction should be made if diabetic control is satisfactory.

We studied the above association using glycated serum proteins which assesses average blood glucose levels over a 2-3 week period. The Bame maternal serum specimens from 132 insulin-dependent diabetic pregnancies that were assayed for MSAFP were also assayed for glycated serum proteins. A non-significant correlation of R .... 10 was found (P = 0.27) for AFP vs. GSP. Our data suggest that the degree of control in maternal diabetes does not significantly influence or alter the level of HSAFP. The alteration in HSAFP observed in pregnant diabetic women may result from the underlying disease process rather than the level of blood glucose control.

We conclude that MSAFP concentrations in in8ulin­dependent patients should be increased by less than 201 rather than earlier recommended adj ustments amounting to increase of as much as 66%.