Volume 166 Number 1, Part 2

121 PREDICTION OF THE NEED FOR I:-iSULIN THERAPY IN GESTATIONAL DIABETES: Ii.Yillw!, G Berkowitz, R Lapinksi', L Lynch, CJ Lockwood. Mt Sinai School of Medicine, New York. NY

Insulin therapy in gestational diabetes mellitus (GDM) is often unduly delayed and fails to prevent diabetic fetopathy. This study sought to identify demographic and laboratory indices associated with the need for insulin therapy. Employing an obstetric database 913 GDM patients were identified by an abnormal glucose tolerance test (GTT) between 1986· 1990. Despite dietary intervention. 220 patients (24%) required insulin therapy due to fasting whole blood glucose levels> 95 mg/dl or post· prandial levels> 120 mg/dl. Significant differences between patients requiring insulin (lRx) and those responding to diet alone (DRx) included: Variable IRx mean (SOl DRx mean (SOl ~2 Pre·pregnancy WI. (lbs.) 161 (44) 141 (35) 0,0001 Body Mass Index (kg/m2) 28.8 (7,1) 25.4 (6.0) 0.0001 1 hr. glucola (mg/dl) 165 (29) 156 (27) 0.0004 Fasting GTT (mg/dl) 101 (20) 93 (14) 0.0001 1 hr. GTT (mg/dl) 207 (31) 196 (24) 0.0001 2 hr. GTT (mg/dl) 179 (36) 169 (27) 0.0004 3 hr. GTT (mg/dl) 136 (41) 129 (32) 0.02 Gest. Age at GTT (wks) 24 (7) 28 (6) 0.0001 Non-white race 81.8% 53.4% 0.0001 Family History DM 39.5% 23.3% 0.0001 Prior History GDM 19.5% 9.0% 0.0001 Prior insulin use 8,1 % 1.6% 0.0001 Logistic regression analysis confinncd that the maternal race, family history of DM. prior insulin use, glucola. fasting and 1 hour GTI values were independent predictors of future insulin use. Therefore a cumulative score for each patient was assigned by multiplying the presence or absence, or value of each risk factor by the appropriate beta and summing. The optimal cut off score, for prediction of insulin use, as assessed by the Receiver-Operator Analysis displayed a sensitivity of 70% and specificity of 70%. SllMMARY: The need for insulin therapy in GDM c:m be predicted by using a combination of maternal characteristics and laboratory values at the time of initial diagnosis.

122 POLYCISTIC OVARY (PCO): A RISK FACTOR FOR GESTATIONAL DIABETES (GD)? A. Caruso x, N. Di Simone x, A, Lanzone x, S. De Carolis x, S. Mancuso x. Dept Ob/Gyn, Catholic University, Rome, Italy.

We found that patients with PCO had a greater secretion of Insulin 0) than controls and about 60% of them showed an hyperinsulinemic (HI) response to OGTT (Hum. Repr.,1990). Eight pts became pregnant within 6 months fol­lowing the evaluation of metabolic status (2 obese, 2 HI obese, Z HI, Z not HI not obese patients). They were tested at 28-30 wks of gestation by OGTI. All these pts had an in­crease of I secretion from 100 to 200%. The integrated secre­tory area of insulin (ISA 1), calculated by trapezoidal rule, of PCO pts was greater than that found in 10 healthy women (p<O.Ol) or in 10 non PCO pts with GD (p<O.OI) tested at the same gestational age and with the same body mass in­dex. GD group had also a decreased ISA I in comparison with controls (p< 0.05). Furthennore the four HI PCO pts developed GD (n-2) or IGGT (n-2). Their ISA I was 50% greater than controls; the other n0n HI PCO pts showed an ISA I after OGTI at the highest values of control group. These data suggest that PCO pts may be considered a spe­cific subgroup of subjects, who may develop a derangement of the glycemic control in spite of their remarkable increase of I secretion during pregnancy. Additional studies need to the knowledge and clinical management of both normal and hyperinsulinemic GD and IGGT in PCO pregnant pa­tients.

SPO Abstracts 313

123 MATERNAL COCAINE AND MARIJUANA USE DETERMINED BY ANAL YSIS OF AMNIOTIC FLUID AND CORD BLOOD AT DELIVERY. C Lowery, C LawlerX, JL Valentine X

, Departments of Obstetrics &. Gynecology and Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Nineteen women presenting for delivery were suspected to be at high risk for substance abuse. Maternal urine and blood, amniotic fluid (AF), and cord blood were collected at delivery. Urine was screened for benzodiazepine, marijuana and cocaine metabolites. opiates and amphetamines using the enzyme multiplied immunoassay technique (EMIT). Only marijuana and eoeaine metabolites were found. Three patients had a positive urine screen for cocaine metabolite, two were positive for cocaine and marijuana metabolites, and two were positive for marijuana metabolite only (36% positive for substance abuse). Amniotie fluid testing for these metabolites using EMIT was negative. Maternal blood and urine, AF,and eord blood were analyzed using gas chroma togra ph y /mass spectrometry (gel ms). Coca i ne and its major metabolite, benzoylecgonine were found in all body fluids; II-nor-9-carboxy-A 9tetrahydro­ca nna binol, a major meta bol i te of the psyehom i met ic agent found in marijuana, was identified in both urine and AF, The relationship between levels found in the four body fluids was variable and is most likely due to differences in metabolism and excretion of the drugs following dosing intervals (which could not be determined). These results represent the first report of cocaine and marijuana metabolites in human AF as determined by gc/ms, Conclusion: Amniotic fluid may represent a potential pharmacokinetic compartment to assess fetal exposure.

124 AN ANONYMOUS COMPARISON OF SUBSTANCE ABUSE BETWEEN CLINIC PATIENTS AND LABOR & DELIVERY PATIENTS IN A RURAL SOUTHERN STATE, CL Lowery, C. Crone,' JM Benanti, R Kirby,X J Valentine,' Departments of OB/GYN and Pediatrtcs, University of Arkansas for Medical Sciences. Little Rock, Arkansas.

Maternal urine was collected during a 30 day period from all patients seen in prenatal clinic (N;386) or on the Labor & Delivery (L&D) Unit (N;227). Urine samples were analyzed for benzodiazepine, marijuana, cocaine metabolites, opiates and amphetamines using enzyme multiplied immunoassay technique (EMIT), and all positive results were confirmed with gas chromatograph y /mass spectrometry (gc/ms). Prevalence rates for marijuana and cocaine were 6.7% and 2.2%, respectively, among in-patients, and 7.6% and 0.8%, respectively, among out-patients. No difference in the prevalence rate for marijuana or cocaine was found between in- and out-patients according to race, maternal age, gestational age, or payment source. Among out­patients, black women were more likely than white women to use cocaine; in general, women;, 37 weeks were more likely to be positive for cocaine (p<.005). Among in-patients, lower gestational age was associated with marijuana use (p<,05), and lack of prenatal care was associated with cocaine use (p<.005). In this study, a lower positive rate was found during urine drug screening than has been reported elsewhere from socioeconomically similar populations. This lower rate presumably reflects a lower incidence of substance abuse at a teaching hospital in a rural southern state.