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Background Breast milk represents the optimal substrate for all infants, including those with a cleft palate for whom growth may be compromised. Objectives Frequency of breast milk feeding at the breast and per feeder (bottle, cup, enteral tube) in infants with cleft palate was determined and compared with rates reported by the Centers for Disease Control and Prevention. A secondary aim was to review growth status of the infants. Design This study represents a 5-year retrospective review using the electronic medical record. Participants and setting Patients were ≤12 months old at the time of the initial, presurgical encounter after a diagnosis of cleft palate had been made and were treated at one of two pediatric cleft palate and craniofacial centers in Ohio between September 30, 2010, and September 30, 2015. Main outcome measures Outcomes measured were breast milk use, reported by mothers and documented in patients' electronic medical records, chronological body weight, as well as weight for length and weight-for-age z scores and percentiles. Statistical analyses performed Descriptive statistics included median with interquartile range and frequency with percentages. World Health Organization z scores were estimated using the Centers for Disease Control and Prevention programs for weight, weight for length, and weight for age at first visit. Comparisons of infants treated at the two hospitals were done using the Wilcoxon rank-sum test or the χ2 test. Results Breast milk consumption (26 infants were breastfed and 84 received human breast milk administered with a device) was 29.5%, markedly below the 2016 Centers for Disease Control and Prevention national statistics for ever receiving breast milk (81%). Anthropometric findings included z scores of −0.95 and −0.42 for weight for age and weight for length, respectively. Conclusions Infants with cleft palate were seldom breastfed, nor was breast milk frequently used. In addition, median weight-for-age and weight-for-length z scores suggest that growth of infants with cleft palate was below normative standards.

Precocious puberty is treated with gonadotropin-releasing hormone agonists (GnRHa). In this study we describe our clinical experience with pubertal suppression from GnRHa, using monthly and 3-monthly formulations. A retrospective chart review for the period between 2006 and 2010 was done for 64 patients who were undergoing treatment for central precocious puberty. Two treatment cohorts were observed for 2+ years. Pubertal suppression was inadequate for 14 of 38 children (37%) on GnRHa given monthly and for 2 of 26 (8%) children given GnRHa every 3 months. Based on our findings of adequate pubertal suppression, decreased frequency of injections, and fewer facility visits, we consider GnRHa 3-monthly injection to be first-line therapy.

The study evaluated the effect of developmental care (DC) on short-term outcome, weight gain, and length of stay in very low-birth-weight infants (1000–1499 grams) and extremely low-birth-weight infants ( P P

Background We sought to evaluate arterial recanalization as measured by changes in the presence of hyperdense artery sign (HAS) on initial and 24-hour computed tomography scans in patients treated with recombinant tissue plasminogen activator (rt-PA) or placebo, and to assess the effect of rt-PA on patient outcomes in this population. Methods Patients in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial composed the study group. We determined the percentage of patients with HAS in rt-PA- and placebo-treated groups who had persistence (HAS +/+) or resolution (HAS +/–) of HAS on 24-hour computed tomography, and compared outcomes in those with resolution or persistence of the sign in these treatment groups. Results Baseline HAS occurred in 79 of 604 eligible patients (13%). The two treatment groups were similar, although patients treated with rt-PA were significantly older. Of the 79 patients with HAS on baseline computed tomography scan, 14 of 37 (38%) treated with rt-PA had resolution of HAS at 24 hours compared with 7 of 42 (17%) treated with placebo ( P = .03). Infarct volumes at 24 hours were significantly smaller in patients treated with rt-PA with resolution of the sign, compared with those who had persistence of the sign ( P = .004). In our analysis, functional outcomes were not significantly improved based on resolution of HAS in either treatment group. There were 4 symptomatic ICHs in the rt-PA–treated group with HAS as compared with two in the placebo-treated group. Conclusion Among patients with HAS at baseline in the NINDS rt-PA Stroke Trial, intravenous rt-PA increased recanalization as measured by resolution of HAS and reduced infarct volumes at 24 hours.

We have previously reported that family history of intracerebral hemorrhage (ICH) was associated with both lobar and nonlobar ICH. We sought to further examine this finding by analyzing differences by age and by apolipoprotein E (Apo E) genotype. All cases of hemorrhagic stroke in the greater Cincinnati area were identified through retrospective screening, and a subset was invited to undergo a direct interview and genetic testing. Interviewed subjects were matched to 2 controls by age, race, and sex. Conditional stepwise logistic regression modeling was used to determine whether having a first-degree relative with an ICH (FHICH) was an independent risk factor for ICH. Between May 1997 and December 2002, we recruited 333 cases of ICH. FHICH was found to be an independent risk factor for both lobar ICH (odds ratio [OR] = 3.9; P = .04) and nonlobar ICH (OR ratio = 5.4; P = .01) after controlling for the presence of numerous variables. Among nonlobar ICH cases, the risk appeared to be predominately in those age70 years. The presence of Apo E4 was associated with lobar ICH at age/= 70 years but not at age70 years. Family history of ICH appears to be a significant risk factor for nonlobar ICH at age70 years. The presence of Apo E4 appears to be a risk factor for lobar ICH at age/= 70 years but not at age70 years. Family history of ICH is a risk factor for lobar ICH after controlling for the presence of Apo E4.

Objective To determine the incidence and obstetric implications and to identify prospectively women with a poor response to hMG with a normal clomiphene citrate challenge test (CCCT) result. Design Retrospective chart review. Setting Tertiary fertility center. Patient(s) One hundred sixty-three women who underwent ovulation induction with hMG for IUI, and 266 women who underwent ovulation induction with GnRH analogue and hMG for IVF. All had a CCCT before stimulation. Seventy-five percent of IUI patients (123 of 163) and 89% of IVF patients (238 of 266) had normal CCCT results. A poor response to hMG was defined as a response less than the 90th percentile of women with an abnormal CCCT result (peak E 2 [pg/mL] level per ampule hMG used: 90th percentile ≤30). Intervention(s) Clomiphene citrate challenge test and ovulation induction for IUI or IVF. Main outcome measure(s) Response to gonadotropins and pregnancy outcome after treatment. Result(s) Thirty-five percent of IUI patients (43 of 123) and 52% of IVF patients (123 of 238) with a normal CCCT result had a poor response to hMG. Intrauterine insemination patients with a poor response to hMG had significantly lower delivery rates than IUI patients with a normal response (19% vs. 39%). In vitro fertilization patients with a poor response to hMG had similar delivery rates compared with IVF patients with a normal response (32% vs. 35%). For both groups of patients, an FSH >12 mIU/mL (IMx assay) on either day 3 or day 10 (normal ≤14.5 IMx) was highly predictive of a poor response to hMG, the elevated FSH level being a much better predictor than the woman's age. Conclusion(s) A poor response to hMG with a normal CCCT result (false negative) is a common event. A day-3 or day-10 FSH >12 mIU/mL (IMx assay) or 20 mIU/mL (converted to the original RIA) will identify approximately 80% (IUI) and approximately 94% (IVF) of the women who will experience a poor response to hMG. When identified, the data suggest that these patients will benefit significantly from the more aggressive IVF.

The purpose of this study was to evaluate placental lesions found in women with preeclampsia compared with normotensive control subjects and to determine whether the presence of these lesions are related to gestational age at delivery.Placental disease of women with preeclampsia at 24 to 42 weeks of gestation was compared with the placental disease of normotensive gestational age-matched control subjects. The placental lesions that were studied specifically included decidual arteriolopathy, thrombi in the fetal circulation, central infarction, intervillous thrombi, and hypermaturity of villi. Data analysis involved the chi(2) test, the Student t test, and logistic regression; odds ratios and CIs were estimated.Placentas from women with preeclampsia (n=158) and normotensive control subjects (n=156) were evaluated. Among women with preeclampsia, 67% had severe disease. Placental lesions were studied according to gestational age at delivery:28, 28 to 32, 33 to 36, andor=37 weeks of gestation. Of the placental lesions that were studied, decidual arteriolopathy (odds ratio, 23.8, 95% CI 10.0-57.0), hypermaturity of villi (odds ratio, 12.4; 95% CI 5.3-29.2), intervillous thrombi (odds ratio, 1.95;95% CI 1.0-3.7), central infarction (odds ratio, 5.9; 95% CI 3.1-11.1), and thrombi in the fetal circulation (odds ratio, 2.8; 95% CI 1.2-6.6) were found to have significantly higher rates in the preeclamptic group. In contrast, the rate of chorioamnionitis was significantly lower in the preeclamptic group (odds ratio, 0.2; 95% CI 0.1-0.4). The rates of abruptio placentae and meconium staining were not different between the two groups. Within the preeclamptic group, the rates of decidual arteriolopathy (P.0001), central infarction (P=.0001), and hypermaturity of villi (P.0001) were higher the earlier the gestational age at delivery.Placentas in women with preeclampsia have increased amounts of disease. The rate is increased with lower gestational ages at the time of delivery for women with preeclampsia.

To date, there have been no population-based data published regarding the influence of the patient’s demographic factors on rt-PA use. We present preliminary data regarding the effect of race and gender on patterns of rt-PA use in the pre-FDA approval era, in a population with demographic and socioeconomic characteristics similar to the United States. All ischemic strokes within a biracial population of 1.3 million were identified by review of all primary and secondary hospital ICD-9-CM codes 430–438 from July 1993 to June 1994 at all hospitals in the region. The number of patients treated with rt-PA or placebo as part of the blinded NINDS rt-PA trial, as well as demographic characteristics, were recorded and analyzed. There were a total of 1973 hospitalized ischemic strokes that occurred at a hospital participating in the NINDS rt-PA trial. Patients that received rt-PA were significantly younger than those that did not (mean age 67 v 72, respectively, P = .01). Of the 413 strokes that occurred in African Americans, 2.2% were treated with rt-PA vs. 2.6% of the 1560 non-African Americans. Women (2.0%) and men (3.0%) were equally likely to receive rt-PA. The single academic center was as likely to give rt-PA as the community medical centers. In the Greater Cincinnati/Northern Kentucky population, patterns of rt-PA use in 1993–94 did not appear to vary according to race or gender, or type of medical center. These findings may be in part because of the regionally-based method of stroke care delivery in the area.

Objective: Endothelin-1 is reportedly elevated in preeclampsia, and studies in our laboratory have shown that infusion of endothelin-1 produces increased mean arterial pressure, hemoconcentration, and proteinuria, while decreasing uterine blood flow. If a role in preeclampsia is confirmed for endothelin-1, therapeutic intervention may involve selective endothelin-A receptor blockers. Thus, this study was designed to determine the effects of Ro 61-1790, a selective endothelin-A receptor inhibitor, on mean arterial pressure, heart rate, and uteroplacental blood flow in pregnant and nonpregnant sheep. Study Design: Seven pregnant and seven nonpregnant sheep were instrumented with indwelling femoral artery and vein catheters and bilateral uterine artery flow probes, allowing determination of mean arterial pressure, heart rate, and uteroplacental blood flow. After baseline administration, animals received intravenous Ro 61-1790 either 1 mg/kg or 3 mg/kg, and hemodynamic responses were monitored for 120 minutes. Results: Intravenous administration of Ro 61-1790 at 1 mg/kg had no effect on the parameters measured in either group studied. However, at 3 mg/kg, Ro 61-1790 caused an increase in total uterine blood flow in nonpregnant sheep from 22 ± 6 mL/min to 51 ± 15 mL/min. This occurred in the absence of significant changes in mean arterial pressure. In pregnant animals, administration of 3 mg/kg Ro 61-1790 decreased mean (± SEM) uteroplacental blood flow by 20% (from 771 ± 130 mL/min to 621 ± 110 mL/min) and increased uterine vascular resistance transiently. Administration of Ro 61-1790 had no significant effect on fetal mean arterial pressure, heart rate, or oxygenation. Conclusions: These data suggest that endogenous endothelin-1 may play an important role in regulating uterine vascular tone in pregnant and nonpregnant sheep and that inhibition of endogenous endothelin-1 may lead to reductions in uteroplacental perfusion in pregnant animals. (Am J Obstet Gynecol 2002;186:55-60.)

Objective: The purpose of this study was to determine whether the combined use of maternal antenatal corticosteroids and antibiotic therapy is associated with an increased risk of late-onset neonatal sepsis among very low birth weight infants. Study Design: The outcomes of infants admitted to the 3 Cincinnati neonatal intensive care units between May 1991 and May 2000 were retrospectively evaluated. Late-onset neonatal sepsis was defined either as the occurrence of a positive blood culture obtained after 72 hours of life with clinical signs of sepsis or as the need for >5 consecutive days of antibiotic therapy for presumed sepsis that initiated after 72 hours of life. Wilcoxon rank sum, chi-square test, and multiple logistic regression were used for analysis. Results: Among the parturients delivering the study infants, 434 women (24%) received corticosteroids only, 175 women (9%) received antibiotics only, 819 women (46%) received both corticosteroids and antibiotics, and 370 women (20%) received neither corticosteroids nor antibiotics. Among 1978 study infants, there were 732 infants (41%) with late-onset neonatal sepsis. By univariate analysis, the odds ratio for late-onset neonatal sepsis caused by combined corticosteroid and antibiotic use was 0.96 (95% CI, 0.89%, 1.04%). Multiple logistic regression analysis was used to evaluate the risk of combined corticosteroids and antibiotic use after controlling for potential covariates and confounders. After controlling for outborn birth (odds ratio, 1.3; 95% CI, 1.0%-1.8%), increasing gestational age at delivery (odds ratio, 0.63; 95% CI, 0.60%-0.66%), interaction between white race and male gender ( P =.01) and interaction between antibiotics and prolonged rupture of membranes ( P =.02), the use of corticosteroids and antibiotics was not associated with an increased risk of late-onset neonatal sepsis ( P =.9). Conclusion: The combined use of maternal corticosteroids and antibiotic therapy is not associated with an increased risk for late-onset neonatal sepsis. (Am J Obstet Gynecol 2001;185:1081-5.)

The purpose of this study was to compare the efficacy of different routes of misoprostol administration for cervical ripening and the induction of labor.Three hundred thirty women ator = 32 weeks gestation with a Bishop scoreor = 6 and an indication for induction were randomized to 1 of 3 double-blinded groups: (1) 25 microg orally administered misoprostol plus 25 microg vaginally administered misoprostol, (2) orally administered placebo plus 25 microg vaginally administered misoprostol, or (3) 25 microg orally administered misoprostol plus vaginally administered placebo. Doses were repeated every 4 hours until onset of labor or a maximum of 12 doses were given. The primary outcome of the trial was vaginal delivery within 24 hours of the initiation of induction. Secondary outcomes were the time from induction to delivery, need for oxytocin augmentation, mode of delivery, frequency of side effects, and neonatal and maternal outcome. Analysis of variance, chi-square test, and logistic regression were used for analysis.There were no significant differences in maternal characteristics or indications for induction. The percentage of women who achieved vaginal delivery within 24 hours was highest in the vaginally administered misoprostol group: 67% compared with 53% in the oral-plus-vaginal group (P.05) and 36% in the oral group (P.05). The median time to vaginal delivery was shorter in the vaginal and oral-plus-vaginal misoprostol groups, 13.5 hours and 14.3 hours, respectively, when compared with 23.9 hours in the oral group (P.05). The rate of cesarean delivery was lowest in the vaginal misoprostol group (17% compared with 30% in the oral-plus-vaginal group and 32% in the oral group; P.05). Uterine tachysystole occurred least frequently in the oral misoprostol group (10% compared with 32% in the vaginal group and 34% in the oral-plus-vaginal group; P.05). Uterine hyperstimulation also occurred least frequently in the oral misopro-stol group (4% compared with 15% in the vaginal group and 22% in the oral-plus-vaginal group; P.05).At the doses studied, induction of labor with vaginally administered misoprostol is more efficacious than either oral-plus-vaginal or oral-only route of administration.

Objective.— To determine the prevalence, trends, and severity of injuries attributable to playground falls relative to other common unintentional mechanisms that resulted in an emergency department (ED) visit in the United States. Design and Setting.— Data from the emergency subset of the National Hospital Ambulatory Medical Care Survey collected from 1992 to 1997 for children Methods.— Injury rates and 95% confidence intervals (CIs) were estimated and injury severity scores were computed. Results.— There were 920 551 (95% CI: 540 803 to 1 300 299) ED visits over the 6-year study period by children and adolescents that were attributable to falls from playground equipment. The annual incidence of visits for playground injuries did not significantly decrease over the course of the study (187 000 to 98 000, P = .053). Injury visits for playground falls were twice as prevalent as pedestrian mechanisms, but they were less prevalent than visits for motor vehicle– and bicycle-related injuries. A larger proportion of playground falls resulted in “moderate-to-severe” injury than did bicycle or motor vehicle injuries. Children aged 5 to 9 years had the highest number of playground falls ( P = .0014). Playground falls were most likely to occur at school compared to home, public, and other locations ( P = .0016). Conclusions.— Playground injury emergency visits have not significantly declined and remain a common unintentional mechanism of injury. Injury visits for playground falls were proportionally more severe than injury visits attributable to other common unintentional mechanisms. Interventions targeting schools and 5- to 9-year-old children may have the greatest impact in reducing emergency visits for playground injuries.

Infertile women undergoing ovulation induction (OI) with clomiphene citrate (CC) who have adequate follicular recruitment and an endometrial thickness of

Objective: To determine the incidence of diminished ovarian reserve (OR) in patients with recurrent pregnancy loss (RPL). Design: Retrospective chart review. Setting: Tertiary fertility center. Patient(s): Six hundred ninety-two women undergoing a fertility evaluation. Intervention(s): Clomiphene citrate challenge test (CCCT). Main Outcome Measure(s): FSH concentrations measured on menstrual days 3 and 10. Result(s): Forty-four women were diagnosed with RPL (+RPL), and 648 women had non-RPL diagnoses (−RPL). Compared with −RPL women, women with +RPL were younger (following statistics are listed as +RPL vs. −RPL, respectively; 34 ± 5 vs. 35 ± 4 y) but had similar menstrual cycle length (29 ± 4 vs. 28 ± 4 d), and lower day 3 FSH levels (8.9 + 7 vs. 11 ± 9 mIU/mL) and similar day 10 FSH levels (11 ± 8 vs. 12 ± 11 mIU/mL). Eight of 44 women with +RPL (18%) had an abnormal CCCT, compared with 117/648 (18%) of women in the −RPL group. For women with normal OR, delivery rates were similar for −RPL and +RPL patients. For women with an abnormal CCCT, delivery rates were Conclusion(s): Women with RPL have a similar incidence of diminished OR as the general infertile population. Reproductive outcome for patients with an abnormal CCCT is equally poor for both groups. Ovarian reserve screening should be considered in the work-up of RPL before initiation of anticoagulant or immunotherapy.

The mechanism for the initiation of human labor remains unknown and is under extensive investigation. Myometrium from patients in labor and not in labor is the ideal tissue to study structural, cellular, and molecular changes that occur during parturition. This study was designed to determine whether myometrial sampling at the time of cesarean delivery increases maternal morbidity.This is a prospective cohort study including 118 study and 236 control patients. A full-thickness myometrial sample was obtained from the superior edge of a transverse uterine incision at the time of cesarean delivery. Demographics and standard surgical morbidity data were collected. Statistical methods used included univariate and multivariate analysis.The study and control groups did not differ significantly with respect to age, gravidity, parity, birth weight, and Apgar scores. The estimated intraoperative blood loss was greater in the control group (P.02); however, the change in hematocrit level (preoperative vs postoperative values) was not different. There were no significant differences in the rates of endometritis, wound infection, and venous thrombosis up to 6 weeks post partum. When study and control patients were stratified into term in labor, term not in labor, preterm in labor, and preterm not in labor categories and compared for maternal morbidity, there were still no significant differences for any of the outcome measures evaluated.On the basis of our data, human myometrial sampling at cesarean delivery does not increase overall maternal morbidity, irrespective of gestational age and the presence or absence of labor.

To determine if elevated serum P concentration on the day of hCG administration or P area under the curve (AUC) impacts on pregnancy rates (PRs) in IVF-ET cycles.Retrospective study.One hundred thirty-three couples underwent IVF-ET using luteal GnRH-agonist suppression followed by hyperstimulation with gonadotropins. Patient cycles were controlled for female age, ovarian reserve, male factor with intracytoplasmic sperm injection (ICSI), endometrial thickness and pattern, number of embryos, and number of high-quality embryos transferred, and cell stage at transfer. Pregnancy was defined as an ongoing pregnancy20 weeks.Patients and cycle parameters did not differ significantly based on the control parameters. Similar numbers of severe male factors treated by ICSI were in each group with similar PRs. Pregnancy rates and implantation rates did not differ based on P levelsor = 0.9,or = 1.1, andor = 1.4 ng/mL (conversion factor to SI unit, 3.18). Serum P concentrations per total eggs retrieved or per mature egg retrieved did not influence pregnancy outcome. Efficiency curves for serum P levels and P AUC did not demonstrate any differences in PR. At very high serum P (P2.0 ng/mL) samples size limits the ability of these data to rule out a negative effect.Serum P levels (and P AUC) commonly encountered during cycles of IVF-ET have no impact on pregnancy outcome.

OBJECTIVE: This study was designed to determine whether pregnancy and increasing parity in women with insulin-dependent diabetes mellitus (1) increases the risk for diabetic nephropathy and (2) accelerates the progression of diabetic nephropathy. STUDY DESIGN: The study included women with insulin-dependent diabetes mellitus who enrolled in our diabetes-in-pregnancy trial with a pregnancy that continued beyond 20 weeks' gestation and who were delivered between 1978 and December 31, 1991, to allow for a minimum of 3 years' follow-up. Pregnancy and follow-up information was obtained from the medical records and from our computerized database. For patients followed up elsewhere, information was obtained from their current physicians. Life-table analysis was used to determine (1) the risk for nephropathy developing de novo as a function of duration of disease and the association of this risk with parity and (2) the risk of renal failure developing in women with preexisting nephropathy and its association with parity. RESULTS: The study population included 182 pregnant women with insulin-dependent diabetes mellitus: 46 with overt nephropathy (group F) and 136 without nephropathy (group NF). Pregnancy and increasing parity did not increase the overall risk for nephropathy (44% after 27 years of diabetes). In group NF 10% had nephropathy within 10.1 ± 4.2 years of the pregnancy. Proteinuria appearing during pregnancy and glycemic control during pregnancy were significantly associated with the subsequent development of nephropathy. In group F 26% had end-stage renal disease after a median period of 6 years from the pregnancy. Pregnancy or increasing parity did not increase the risk for renal failure in women with nephropathy. CONCLUSIONS: Our data support the premise that pregnancy in women with insulin-dependent diabetes mellitus does not increase the risk of subsequent nephropathy and does not accelerate progression of renal disease in women with preexisting nephropathy. (AM J OBSTET GYNECOL 1996;174:1180-91.)

The potential additive effect of obesity on selected nutritional, immunologic, hormonal, and clinical outcome parameters was evaluated.Fifteen obese patients were randomly matched for age, percentage of burn, percentage of third-degree burn, and inhalation injury to 15 nonobese patients.Subjects were admitted to Shriners Burns Institute or University Hospital in Cincinnati, Ohio.The results of this study established a significant relationship between obesity and morbidity. Incidence of infection was greatest in the obese group (P.03). Bacteremia (P.008) and clinical sepsis (P.005) occurred concomitant with obesity. The obese group required significantly (P.05) more days on mechanical ventilatory support. Exogenous insulin supplementation (obese = 14.5 +/- 5.3 days, nonobese = 6.2 +/- 2.2 days) and antibiotic therapy (obese = 8.5 +/- 2.3 days, nonobese = 3.4 +/- 1.5 days) were required more than twice as many days in the obese group, although these trends did not reach statistical significance. Resting energy expenditure measurements were significantly higher in the obese group during weeks 1 (P.0006) and 2 (P.02), and the trend continued into weeks 3 and 4. Transferrin values for the obese group remained suppressed throughout the first 4 weeks after the burn, whereas the transferrin levels of the nonobese group were normal by week 4. Compared with normal-weight burn patients, obese burn patients had markedly lower alpha 2-macroglobulin values and higher glucagon levels throughout the study period.The data demonstrate the many metabolic and biochemical aberrations associated with obesity, distinct from the burn injury itself, and suggest that the overweight burn patient is at increased risk of morbidity. Given the prevalence of obesity in the United States, greater attention clearly needs to be given to its prevention and management.

Patients with insulin-dependent diabetes are prone to infection, possibly related to poor metabolic control. Relative immune deficiency exists in pregnancy. We hypothesized that pregnant patients with insulin-dependent diabetes are at an increased risk for infection and that infection is related to poor glycemic control. We matched 65 pregnant women with insulin-dependent diabetes to 65 nondiabetic pregnant controls. At least one episode of infection before delivery occurred in 83% of the women with insulin-dependent diabetes (26% in control group). The rate of postpartum infection was five times higher in the group with insulin-dependent diabetes and they were susceptible to more kinds of infections. Although there was no overall difference among the indices of glycemic control, hemoglobin A1 obtained before the infection was higher than during infection. We conclude that a high rate of infection exists in pregnant women with diabetes; infection and poor glycemic control may be associated, but it is unclear whether improvement in metabolic control will reduce this high infection rate.

THE EXPECTED CHANGE OVER TIME? SHAD DEERING, SARAH POGGI, CATHERINE SPONG, FRANCA BARTON, KATIE GOODWIN, ALESSANDRO GHIDINI, Georgetown University, Obstetrics and Gynecology, Washington, DC Georgetown University, Biostatistics, Washington, DC OBJECTIVE: To assess the change in the lamellar body count (LBC) in patients undergoing repeat testing for fetal lung maturity to see if a predictable change in LBC over a given period of time exists. STUDY DESIGN: We analyzed a cohort of women from 1998 to 2003 at a single institution who underwent amniotic fluid sampling at least twice during pregnancy for determination of fetal lung maturity. Charts were reviewed and maternal demographic information, as well as data regarding the gestational age at sampling and the LBC, were recorded. This study was approved by the institutional review board. Statistical analysis included linear regression of LBC and gestational age. RESULTS: There were a total of 24 patients who had at least two samples taken during the study period for a total of 57 samples. Themean gestational age at sampling was 34.8 ± 0.3 weeks. Linear regression demonstrated that the LBC count increased by 5087 per week (P = 0.008). This increase did not change significantly with increasing gestational age. CONCLUSION: The LBC count increases approximately 5100 per week during pregnancy after 28 weeks’ gestation and the rise appears to be consistent and linear. This information may be beneficial in determining when a patient can be expected to have a level consistent with fetal lung maturity after a given LBC and therefore have a low risk of RDS.

To identify predictors of clinical coronary artery disease, 110 insulin-requiring diabetic patients with no symptoms suggestive of cardiac disease and with a normal resting ECG underwent metabolic and noninvasive cardiovascular screening including a history and physical examination, exercise ECG, M-mode echocardiography, and chemical laboratory testing. During a median follow-up interval of 100 months, 14 of these patients had clinical evidence of coronary artery disease consisting of acute myocardial infarction, sudden cardiac death, or anginal chest pain with angiographic documentation of occlusive coronary artery disease. Baseline variables that were univariately predictive of subsequent clinical coronary disease included age, peak treadmill heart rate, and retinal neovascularization. According to multivariate analysis the peak treadmill heart rate was the single most important predictor of subsequent development of clinical coronary disease. A treadmill ECG result that was either abnormal or inconclusive because of failure to achieve 90% of predicted maximal heart rate identified each patient in whom clinical coronary artery disease developed within 50 months after entry testing. Thus the entry treadmill ECG provided prognostic information not available from the history and physical examination results, but little further prognostic information was provided after the first 50 months of follow-up, suggesting the need for serial testing.