Volume 166 Number I, Part 2

97 MATERNAL-PERINATAL OUTCOME IN WOMEN WITH CARDIAC DISEASE. N. Meyer,' B. Sibai, B. Mercer: A. Khoury,X R. Brazzel,x

O. Portera.x University of Tennessee. Memphis. The purpose of this study is lO report maternal and perinatal outcome

in pregnancies complicated by maternal cardiac disease. The study population included 54 women with documented cardiac disease prior to the onset of pregnancy. Eight women had various cardiac arrhythmias, 5 had mitral valve prolapse. These 13 women had 14 pregnancies at term without maternal complications. Three women had aortic insufficiency; 1 developed pulmonary edema during labor. Two women had tetralogy of Fallot; both pregnam;ies resulted in live full term babies; however, 1 patient developed postpartum left middle cerebral artery embolus. Two patients with myocardial infarction de!ivered 3 liveborn infants without any maternal complications. Pregnancy outcome in the remaining 30 women is summarized in the table. Conclusions: proper management of women with cardiac disease results in good maternal/perinatal outcome. However, women with tricuspid atresia and/or pulmonary hypertension and cardiomyopathy remain at increased risk for maternal morbidity and mortality.

ASD/ Aortic/ Tricuspid Cardio-VSD pUlmonic atresia myo-

stenosis PuIm.HTN pathy n-15 11=8 n--4 n-7

No. of pregnancies 21 12 4 9 Deliv. ga (wk) 37.5±3.6 38.5±2.7 35.3t2.3 37.8±3.5 Preterm<37 weeks 4(19) 2(16) 2(50) 2(22) Birthweight (g) 3015±775 3 I34±540 2218±646 2732±782 < 10th percentile # (%) 1(5) 1(8) 2 (67) 3 (33) Perinatal deaths # (%) 0 0 1(25)* 0 Maternal deaths # (%) 0 0 2(50) I (9)**

ASD=atrial septal defect, VSD=ventricular septal defect, *=1 had pregnancy termination, **=died 2 months postpartum.

98 PERINATAL OUTCOME AND DIABETES MELLITUS

L.B. Curet, L. Izquierdo, G. Gilson, M. ChatteIjee, G. Del Valle, G. Joffe, D. Jones" M. ViW, Dept. of OB/GYN, University of New Mexico, Albuquerque, NM

125 insulin dependent patients were cared f(,r during their pregnancies according to the following protocol: Diet: 24-30 calories/kg b.w., 20% as protein, 50% as CHO, 30% as fat, 3 meals and 3 snacks/day. Insulin 0.5-1.0 u. Reg insulin/kg h.w. with 40% before breakfast, 30% before lunch, 20% before supper and 10% at bedtime. 2-4 u. NPH h.s. Exercise: aerobic at least 3 times/week. Glucose determinations: fasting and 2-hour post prandials at least 3 times/week. Goal: Maintain FBS and 2-hour p.p. below 150 mgm/dl. Results: Mean b.g. by trimesters-first: 143 mgm/dl 2d: 131 3d: 131. Mean FBS-144 mgm/dl, post breakfast-146, post lunch-I 16, post supper-125. B.W. >4 kg-II %. Neonatal hypoglycemia-9%. Incidence of Iga with mean b.g. 120:17%, with b.g. 120-150: 30%, with b.g. > 150:30%. Perinatal mortality: 3.1 %, due to anomalies: 317 (43%).

Conclusion: 150 mgm/dl is an adequate endpoint with acceptable perinatal mortality/morbidity and a low incidence of maternal hypoglycemia. The size of the neonate is significantly lowered only if the maternal b.g. is kept below 120 mgm/dl. Preconceptional control seems mandatory to minimize congenital malformations and perinatal mortality.

SPO Abstracts 307

99 PERINATAL OUTCOME IN PREGNANCY COMPLICATED BY MASSIVE OBESITY Perlow JH" Montgomery DMx, Morgan MA, Towers CV, Porto M L:mg Reach Memorial Womens Hospital, Long Beach. California University of California, Irvine Medical Center. Orange. CA

The purpose of this study was to evaluate the impact of massive obesity on pregnancy outcome. Between 1/1/86 and 12/31/90, women weighing >300 lb at delivery (n=111, 0.43% incidence) comprised the study group (G 1). To control for confounding variables. another group (02) was comprised of the massively obese patients without the complications of diabetes and/or hypertension. A control group (CG, n=112) matched for maternal age and parity, was consecutively selected following each case delivery. Perinatal outcome was analyzed between groups and is demonstrated below.

Outcome %GI %CG %02 P values n~111 n=112 n=86 GlvCG G2vCG

10 Cesarean 32.4 IS. I 19.5 .0004 NS BWT >4kg 30.2 11.3 14.6 .0005 NS BWT < 2.5kg 14.7 3.8 3.7 .008 NS IUGR 8.1 0.9 4.9 .03 NS NICU ADMIT 15.5 4.7 4.9 .01 NS Preeclampsia 4.5 0.0 4.9 .07 NS Class B DM 19.8 2.7 .00006 Class A DM 5.4 0.9 NS Hypertension 27.0 0.9 .0001

Conclusion: Massively obese patients without confounding medical complications had a pregnancy outcome similar to controls. These data may be useful in preconceptual and prenatal counseling, and in perinatal management of the massively obese patient.

100 SEVERITY OF ASTHMA AND PREGNANCY OUTCOME: A CASE CONTROL STUDY Perlow rn\ Montgomery DMx, Morgan MA, Towers CV, Porto M Long Beach Memorial Womens Hospital, Long Beach, CA University of California Irvine Mcd Center, Orange, California

Between 1/1/81 and 12/31/90, 183 patients delivered who had the diagnosis of asthma (incidence 0.59%). 81 patients were identified as requiring medication control (ie steroids, theophylline, betamimetics, etc.) throughout pregnancy. These patients included 50 non-steroid dependent asthmatics (NSA) and 31 steroid dependent asthmatics (SA), and were compared with a group of 130 randomly selected patients (CO), excluding maternal transpOrls. All three groups were similar for BWT <1500 gm. low 5 minute Apgar. JUFD. hypertension, preeclampsia, and anomalies. The remainder of perinatal outcome analysis is demonstrated in the table below:

Outcome %SA %NSA %CG P values n-31 n-SO n-130 SAvNSA SAvCG NSAvCG

BWT <2S00 gm (LBW) 4S.2 14.0 4.6 <.01 <.01 .06 Deliv. <37wk (PTD) 54.8 14.0 3.9 <.01 <.01 .03 Pretenn Labor (PTL) 48.4 10.0 1.6 <.01 <.01 .03 PROM 25.8 10.0 1.6 NS <.01 .04 CIS Distress 16.1 14.0 1.6 NS <.01 <.01 Class A2 Diabetes 9.7 4.0 .78 NS .03 NS Class B Diabetes 6.9 2.0 0 NS .04 NS

These data suggest that medication dependent pregnant asthmatics are at increased risk for perinatal morbidity. Risk factor counseling, preterm labor prevention and assessment, and early screening for diabetes should be considered.