Abstract Disclosure: P. Chilukuri: None. J. Llanora: None. A. Schadler: None. K. Playforth: None. K. Naseman: None. Objective: Diabetes complicates up to 17% of pregnancies in the United States annually. Self-monitoring of blood glucose for diabetics requires supplies, knowledge, and support. Continuous glucose monitor (CGM) use for self-monitoring improves clinical outcomes and patient satisfaction. Despite identified benefits, patient access to CGM is variable. Identifying barriers to CGM access is important to promote health equity. Our objective was to describe CGM prevalence in a pregnant population with diabetes. Study Design: This was a single-center, retrospective observational cohort study using electronic health record review of pregnant patients with diagnoses of Type 1 Diabetes (T1DM), Type 2 Diabetes (T2DM), or gestational diabetes (GDM). Patients ages 18 to 50 years with state Medicaid insurance, for whom CGM is a covered benefit, were considered if seen in any of our institution’s obstetrics clinics within a one-year period. Type of diabetes, race/ethnicity, primary language, home county, medication use, and CGM orders were abstracted. Pearson’s Chi-square, Fisher’s exact, and independent samples t-tests were used for analysis. Results: Of 297 total patients, 7.7% (n=23) had T1DM, 22.2% (n=66) had T2DM, 68.4% (n=203) had GDM, and 1.7% (n=5) had another type. Overall, 19% (n=55) had reported CGM use. There was no difference in CGM use for non-white vs. white race (p=0.081) and urban vs. rural home county (p=0.138). Significantly less non-English speaking patients (p=0.001), Hispanic patients (p=0.026), Metformin users (p=0.03), and those not taking medications (p< 0.001) used CGM. Significantly more T1DM (p< 0.001), T2DM (p=0.007), and insulin-using patients (p<0.001) were in the CGM group. Conclusion: In patients with insurance coverage of CGM, awareness of actual usage is key. Social factors of ethnicity and primary language and clinical factors of diabetes type and medication use may affect CGM use. Obstetricians should advocate for equal CGM access for high-risk patients to improve patient outcomes and satisfaction. Presentation: Saturday, June 17, 2023

ObjectiveOmentin is a novel adipokine that is preferentially produced by visceral adipose, but is also strongly expressed by the ovary and placenta. Omentin enhances glucose uptake and decreases insulin resistance. Little is known about the role of omentin in pregnancy. The purpose of this study is to examine the role of omentin in gestational diabetes (GDM) versus non-diabetic controls.Study DesignPregnant women (17 GDM, 15 controls) were enrolled between 24 and 34 weeks gestation after diagnosis by glucose challenge testing. Serum omentin levels were compared between gestational diabetics and non-diabetics. Statistical analyses included t-test, ANOVA, and linear regression analysis.ResultsThe mean values of omentin were similar between gestational diabetics versus controls (1.3 versus 1.2). With linear regression analysis, although not statistically significant, trends indicate that for patients with known serum glucose levels less than 300 (14 GDM, 10 controls) serum omentin levels are positively correlated with serum glucose levels in gestational diabetics (p = 0.07) but not correlated for non-diabetics (p = 0.76).ConclusionElevated omentin levels were associated with higher screening glucose levels in gestational diabetics. The up-regulation of omentin expression in GDM may implicate a novel mechanism of placental glucose homeostasis in pregnancy. Further study is needed to elucidate the purpose of placental expression of omentin and its role in pregnancy. ObjectiveOmentin is a novel adipokine that is preferentially produced by visceral adipose, but is also strongly expressed by the ovary and placenta. Omentin enhances glucose uptake and decreases insulin resistance. Little is known about the role of omentin in pregnancy. The purpose of this study is to examine the role of omentin in gestational diabetes (GDM) versus non-diabetic controls. Omentin is a novel adipokine that is preferentially produced by visceral adipose, but is also strongly expressed by the ovary and placenta. Omentin enhances glucose uptake and decreases insulin resistance. Little is known about the role of omentin in pregnancy. The purpose of this study is to examine the role of omentin in gestational diabetes (GDM) versus non-diabetic controls. Study DesignPregnant women (17 GDM, 15 controls) were enrolled between 24 and 34 weeks gestation after diagnosis by glucose challenge testing. Serum omentin levels were compared between gestational diabetics and non-diabetics. Statistical analyses included t-test, ANOVA, and linear regression analysis. Pregnant women (17 GDM, 15 controls) were enrolled between 24 and 34 weeks gestation after diagnosis by glucose challenge testing. Serum omentin levels were compared between gestational diabetics and non-diabetics. Statistical analyses included t-test, ANOVA, and linear regression analysis. ResultsThe mean values of omentin were similar between gestational diabetics versus controls (1.3 versus 1.2). With linear regression analysis, although not statistically significant, trends indicate that for patients with known serum glucose levels less than 300 (14 GDM, 10 controls) serum omentin levels are positively correlated with serum glucose levels in gestational diabetics (p = 0.07) but not correlated for non-diabetics (p = 0.76). The mean values of omentin were similar between gestational diabetics versus controls (1.3 versus 1.2). With linear regression analysis, although not statistically significant, trends indicate that for patients with known serum glucose levels less than 300 (14 GDM, 10 controls) serum omentin levels are positively correlated with serum glucose levels in gestational diabetics (p = 0.07) but not correlated for non-diabetics (p = 0.76). ConclusionElevated omentin levels were associated with higher screening glucose levels in gestational diabetics. The up-regulation of omentin expression in GDM may implicate a novel mechanism of placental glucose homeostasis in pregnancy. Further study is needed to elucidate the purpose of placental expression of omentin and its role in pregnancy. Elevated omentin levels were associated with higher screening glucose levels in gestational diabetics. The up-regulation of omentin expression in GDM may implicate a novel mechanism of placental glucose homeostasis in pregnancy. Further study is needed to elucidate the purpose of placental expression of omentin and its role in pregnancy.

Nearly all pregnancies include an insignificant hemorrhage of fetal blood into the maternal circulation. In some cases, the hemorrhage is large enough to compromise the fetus, resulting in fetal demise, stillbirth, or delivery of a severely anemic infant. Unfortunately, the symptoms of a significant fetal-maternal hemorrhage can be subtle, nonspecific, and difficult to identify at the time of the event. We present the case of a severely anemic newborn who was delivered in our facility with an extensive literature review.

To evaluate the effect of body mass index on electrical uterine activity during labor. Eighty-four patients admitted to Labor & Delivery at RooseveltHospital, who met study criteria, were recruited to join a prospective, blinded, IRB-approved study. Electrical activity of the uterine myometrium was measured with electromyography as previously described. The EUM-100 electromyogram (EMG) machine (OB Tools) employed used 9-electrodes, a multi-channel signal amplifier with high and low-pass filters, and a 3-dimensional position sensor to measure the electrical depolarization of the uterine myometrium. In addition, the EUM-100 is designed to control for the different thickness of the abdominal wall during measurement of uterine electrical activity. EUM data were recorded and sent offsite to an analyst blinded to clinical data.This measurement was converted via computer algorithm into Peak Root Mean Square (pRMS). Maternal demographic and pregnancy outcome data were obtained from medical records. BMI information was available for comparison with 144 electromyography measurements. Student's t test and Pearson's correlations were used to test for statistical significance. The study revealed: (1) There was a negative linear correlation between BMI and electrical uterine activity (r= -0.40); (2) When BMI was separated into WHO categories, there were statistically significant differences in the mean pRMS for normal-weight versus overweight and obese individuals (513 vs. 428; p=0.0026 and 513 vs. 437; p=0.0048); and, (3) There were no statistically significant differences in the mean pRMS of underweight versus normal-weight individuals (509 vs. 513; p=0.83) or in the mean pRMS of overweight versus obese individuals (428 vs. 437; p=0.36). Our data suggests that electrical uterine activity decreases as body mass index increases. This difference is most notable between normal weight and overweight individuals.

ObjectiveWe sought to compare the electrical uterine activity in spontaneous and induced labor as measured longitudinally throughout labor progression.Study DesignForty-five patients admitted to Labor & Delivery at Roosevelt Hospital were recruited to join a prospective, blinded, IRB-approved study. All patients included in the study had two or more measurements of electrical uterine activity via electromyography conducted during the course of labor—at least one measurement during latent phase and one in active phase. Electrical uterine activity at preset intervals was then compared between those in spontaneous labor and those undergoing induction of labor with pitocin. The electrical uterine activity was measured via electromyography (EMG) as previously described by several authors. The EUM-100 electromyogram machine used, employs 9 electrodes, a multi-channel signal amplifier with high and low-pass filters, and a 3-dimensional position sensor to measure the electrical depolarization of the uterine myometrium. EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis. The measurements are converted via computer algorithm into Peak Root Mean Square (pRMS). Student's t-tests were used to perform statistical analysis.ResultsThe study revealed: (1) The electrical uterine activity in latent labor (<4cms) is similar between spontaneous and induced labor. (p=0.97); (2) The electrical uterine activity in spontaneous labor continues to increase linearly throughout labor; (3) In induced labor, the electrical uterine activity remains fairly constant; (4) Beginning at approximately 6 cms dilatation, a trend in increased uterine electrical activity is seen in spontaneous labor (p=0.14).ConclusionOur data suggests that electrical uterine activity in spontaneous labor is physiologically different than in induced labor. ObjectiveWe sought to compare the electrical uterine activity in spontaneous and induced labor as measured longitudinally throughout labor progression. We sought to compare the electrical uterine activity in spontaneous and induced labor as measured longitudinally throughout labor progression. Study DesignForty-five patients admitted to Labor & Delivery at Roosevelt Hospital were recruited to join a prospective, blinded, IRB-approved study. All patients included in the study had two or more measurements of electrical uterine activity via electromyography conducted during the course of labor—at least one measurement during latent phase and one in active phase. Electrical uterine activity at preset intervals was then compared between those in spontaneous labor and those undergoing induction of labor with pitocin. The electrical uterine activity was measured via electromyography (EMG) as previously described by several authors. The EUM-100 electromyogram machine used, employs 9 electrodes, a multi-channel signal amplifier with high and low-pass filters, and a 3-dimensional position sensor to measure the electrical depolarization of the uterine myometrium. EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis. The measurements are converted via computer algorithm into Peak Root Mean Square (pRMS). Student's t-tests were used to perform statistical analysis. Forty-five patients admitted to Labor & Delivery at Roosevelt Hospital were recruited to join a prospective, blinded, IRB-approved study. All patients included in the study had two or more measurements of electrical uterine activity via electromyography conducted during the course of labor—at least one measurement during latent phase and one in active phase. Electrical uterine activity at preset intervals was then compared between those in spontaneous labor and those undergoing induction of labor with pitocin. The electrical uterine activity was measured via electromyography (EMG) as previously described by several authors. The EUM-100 electromyogram machine used, employs 9 electrodes, a multi-channel signal amplifier with high and low-pass filters, and a 3-dimensional position sensor to measure the electrical depolarization of the uterine myometrium. EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis. The measurements are converted via computer algorithm into Peak Root Mean Square (pRMS). Student's t-tests were used to perform statistical analysis. ResultsThe study revealed: (1) The electrical uterine activity in latent labor (<4cms) is similar between spontaneous and induced labor. (p=0.97); (2) The electrical uterine activity in spontaneous labor continues to increase linearly throughout labor; (3) In induced labor, the electrical uterine activity remains fairly constant; (4) Beginning at approximately 6 cms dilatation, a trend in increased uterine electrical activity is seen in spontaneous labor (p=0.14). The study revealed: (1) The electrical uterine activity in latent labor (<4cms) is similar between spontaneous and induced labor. (p=0.97); (2) The electrical uterine activity in spontaneous labor continues to increase linearly throughout labor; (3) In induced labor, the electrical uterine activity remains fairly constant; (4) Beginning at approximately 6 cms dilatation, a trend in increased uterine electrical activity is seen in spontaneous labor (p=0.14). ConclusionOur data suggests that electrical uterine activity in spontaneous labor is physiologically different than in induced labor. Our data suggests that electrical uterine activity in spontaneous labor is physiologically different than in induced labor.

ObjectiveA key component in the management of GDM is diet therapy and limitation of caloric intake. However, adherence to a strict diet with good glycemic control often results in limited third trimester weight gain and many women fear that poor weight gain in pregnancy may compromise the health of the fetus.The purpose of this study was to test the hypothesis that limited third trimester weight gain in GDM is associated with a decreased risk of LGA without increasing the risk of SGA.Study DesignA retrospective analysis of data on 230 women with GDM who were managed in our Diabetes in Pregnancy Program in 2007 was performed. Good glycemic control was defined as >80% of blood glucose values within target limits and mean blood glucose <105 mg/dL. Total and weekly weight gain were determined for the duration of GDM management to the time of delivery. Infant birth weight (BW) was categorized as a percentile for gestational age at delivery and patients were stratified by pre-pregnancy BMI. Statistical analysis included one way ANOVA, chi-square, Fisher's exact test and Student's t-test.ResultsMaternal BMI was not significantly associated with weight gain in pregnancy or with BW percentile. Total and weekly weight gain during GDM treatment were positively associated with BW percentile. Limited (<0.5 pounds per week) maternal weight gain during GDM treatment was not associated with an increased risk of SGA in any BMI category. Poor glycemic control was significantly associated with risk of LGA. Multiple logistic regression anaylysis that included weight gain, BMI and glycemic control revealed that weight gain alone was significantly associated with BW percentile.ConclusionLimited weight gain in women with GDM is associated with a decreased risk of excessive fetal growth and does not increase the risk of SGA. We speculate that stunted weight gain in these women reflects improved metabolic control that modifies the process of diabetic fetopathy. ObjectiveA key component in the management of GDM is diet therapy and limitation of caloric intake. However, adherence to a strict diet with good glycemic control often results in limited third trimester weight gain and many women fear that poor weight gain in pregnancy may compromise the health of the fetus.The purpose of this study was to test the hypothesis that limited third trimester weight gain in GDM is associated with a decreased risk of LGA without increasing the risk of SGA. A key component in the management of GDM is diet therapy and limitation of caloric intake. However, adherence to a strict diet with good glycemic control often results in limited third trimester weight gain and many women fear that poor weight gain in pregnancy may compromise the health of the fetus.The purpose of this study was to test the hypothesis that limited third trimester weight gain in GDM is associated with a decreased risk of LGA without increasing the risk of SGA. Study DesignA retrospective analysis of data on 230 women with GDM who were managed in our Diabetes in Pregnancy Program in 2007 was performed. Good glycemic control was defined as >80% of blood glucose values within target limits and mean blood glucose <105 mg/dL. Total and weekly weight gain were determined for the duration of GDM management to the time of delivery. Infant birth weight (BW) was categorized as a percentile for gestational age at delivery and patients were stratified by pre-pregnancy BMI. Statistical analysis included one way ANOVA, chi-square, Fisher's exact test and Student's t-test. A retrospective analysis of data on 230 women with GDM who were managed in our Diabetes in Pregnancy Program in 2007 was performed. Good glycemic control was defined as >80% of blood glucose values within target limits and mean blood glucose <105 mg/dL. Total and weekly weight gain were determined for the duration of GDM management to the time of delivery. Infant birth weight (BW) was categorized as a percentile for gestational age at delivery and patients were stratified by pre-pregnancy BMI. Statistical analysis included one way ANOVA, chi-square, Fisher's exact test and Student's t-test. ResultsMaternal BMI was not significantly associated with weight gain in pregnancy or with BW percentile. Total and weekly weight gain during GDM treatment were positively associated with BW percentile. Limited (<0.5 pounds per week) maternal weight gain during GDM treatment was not associated with an increased risk of SGA in any BMI category. Poor glycemic control was significantly associated with risk of LGA. Multiple logistic regression anaylysis that included weight gain, BMI and glycemic control revealed that weight gain alone was significantly associated with BW percentile. Maternal BMI was not significantly associated with weight gain in pregnancy or with BW percentile. Total and weekly weight gain during GDM treatment were positively associated with BW percentile. Limited (<0.5 pounds per week) maternal weight gain during GDM treatment was not associated with an increased risk of SGA in any BMI category. Poor glycemic control was significantly associated with risk of LGA. Multiple logistic regression anaylysis that included weight gain, BMI and glycemic control revealed that weight gain alone was significantly associated with BW percentile. ConclusionLimited weight gain in women with GDM is associated with a decreased risk of excessive fetal growth and does not increase the risk of SGA. We speculate that stunted weight gain in these women reflects improved metabolic control that modifies the process of diabetic fetopathy. Limited weight gain in women with GDM is associated with a decreased risk of excessive fetal growth and does not increase the risk of SGA. We speculate that stunted weight gain in these women reflects improved metabolic control that modifies the process of diabetic fetopathy.

ObjectiveTo characterize the myometrial electrical activity during induced labor in patients who received cervidil for cervical ripening compared to those receiving pitocin only.Study DesignPatients undergoing induction of labor were recruited into a prospective, double-blind IRB-approved study. Demographic data and Bishop Score were determined at baseline. Cervidil was placed in all patients with baseline Bishop Score 4. Patients with Bishop score >4 received pitocin. Electrical activity of the uterine myometrium was measured with a multi-channel electromyogram (EMG) amplifier and a 3-dimensional position sensor at preset intervals. EMG and cervical exam data were obtained within 2 hours of placement of cervidil, at cervidil removal, at entry into active phase of labor (4 cms cervical dilatation), and every 2 hours during active labor. EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis.ResultsTwenty patients participated in the study (10 cervical ripening and 10 pitocin induction). There was no difference between the 2 groups in age, parity, BMI, or race. Evaluation with the EMG revealed no difference in the electrical uterine activity between those with cervidil and those without during the latent phase of labor (cervical dilatation <4 cms). There was marginally increased electrical uterine activity in the cervidil group during the active phase of labor (cervical dilatation 4 cms) (511.6 vs. 445.8, p=0.06). In patients who received cervidil for cervical ripening, the maximum pitocin dose received was lower (11munits vs. 16 munits, p=0.068).ConclusionOur data suggests that patients undergoing cervical ripening with cervidil may develop stronger uterine contractions during the active phase of labor with lower doses of pitocin. ObjectiveTo characterize the myometrial electrical activity during induced labor in patients who received cervidil for cervical ripening compared to those receiving pitocin only. To characterize the myometrial electrical activity during induced labor in patients who received cervidil for cervical ripening compared to those receiving pitocin only. Study DesignPatients undergoing induction of labor were recruited into a prospective, double-blind IRB-approved study. Demographic data and Bishop Score were determined at baseline. Cervidil was placed in all patients with baseline Bishop Score 4. Patients with Bishop score >4 received pitocin. Electrical activity of the uterine myometrium was measured with a multi-channel electromyogram (EMG) amplifier and a 3-dimensional position sensor at preset intervals. EMG and cervical exam data were obtained within 2 hours of placement of cervidil, at cervidil removal, at entry into active phase of labor (4 cms cervical dilatation), and every 2 hours during active labor. EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis. Patients undergoing induction of labor were recruited into a prospective, double-blind IRB-approved study. Demographic data and Bishop Score were determined at baseline. Cervidil was placed in all patients with baseline Bishop Score 4. Patients with Bishop score >4 received pitocin. Electrical activity of the uterine myometrium was measured with a multi-channel electromyogram (EMG) amplifier and a 3-dimensional position sensor at preset intervals. EMG and cervical exam data were obtained within 2 hours of placement of cervidil, at cervidil removal, at entry into active phase of labor (4 cms cervical dilatation), and every 2 hours during active labor. EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis. ResultsTwenty patients participated in the study (10 cervical ripening and 10 pitocin induction). There was no difference between the 2 groups in age, parity, BMI, or race. Evaluation with the EMG revealed no difference in the electrical uterine activity between those with cervidil and those without during the latent phase of labor (cervical dilatation <4 cms). There was marginally increased electrical uterine activity in the cervidil group during the active phase of labor (cervical dilatation 4 cms) (511.6 vs. 445.8, p=0.06). In patients who received cervidil for cervical ripening, the maximum pitocin dose received was lower (11munits vs. 16 munits, p=0.068). Twenty patients participated in the study (10 cervical ripening and 10 pitocin induction). There was no difference between the 2 groups in age, parity, BMI, or race. Evaluation with the EMG revealed no difference in the electrical uterine activity between those with cervidil and those without during the latent phase of labor (cervical dilatation <4 cms). There was marginally increased electrical uterine activity in the cervidil group during the active phase of labor (cervical dilatation 4 cms) (511.6 vs. 445.8, p=0.06). In patients who received cervidil for cervical ripening, the maximum pitocin dose received was lower (11munits vs. 16 munits, p=0.068). ConclusionOur data suggests that patients undergoing cervical ripening with cervidil may develop stronger uterine contractions during the active phase of labor with lower doses of pitocin. Our data suggests that patients undergoing cervical ripening with cervidil may develop stronger uterine contractions during the active phase of labor with lower doses of pitocin.

To characterize the electrical uterine activity during induced labor in comparison to spontaneous labor. Twenty patients undergoing induction of labor and 20 patients in spontaneous labor were recruited into a prospective, double-blind, IRB-approved study. Cervical characteristics and stage of labor were determined at baseline. Electrical activity of the uterine myometrium was measured with a multi-channel electromyogram (EMG) amplifier and a 3-dimensional position sensor at preset intervals. EMG data and cervical exam were obtained at study entry, at 4 cms cervical dilatation, and every 2 hours during active labor (cervical dilatation 4 cms). EMG data was recorded and sent offsite to an individual blinded to all clinical data for analysis. Both cross-sectional and longitudinal data analysis was performed. The study revealed: (1) the electrical uterine activity during active labor (cervical dilatation 4 cms) in patients undergoing induction was significantly higher than in patients in spontaneous labor (p=0.018)(500.4 vs. 420.7); (2) the electrical uterine activity during latent labor (cervical dilatation <4 cms) was not significantly different between the 2 groups; (3) in the induction patients, a higher level of electrical uterine activity was seen in active labor in comparison to latent labor (471.6 vs. 522.4 p=0.06); (4) no correlation was found between the level of electrical activity during the induction and maximum pitocin dose given; and (5) significant correlation was found between the level of electrical uterine activity in latent labor and active labor (r=0.61, p=0.02). The electrical uterine activity achieved during the active phase of induced labor is significantly greater than in spontaneous labor. Our data suggests that patient′s response to pitocin has marked individuality.

Controversy exists regarding the effect of epidural anesthesia on progress of labor. We sought to determine if epidural anesthesia affects electrical uterine activity during active labor. In a prospective double-blind study of women at term with normal labor (Friedman) curves, epidural anesthesia was placed during the active phase of labor. Electrial uterine activity and cervical characteristics were measured at least 30 minutes before administration and within one hour after completion of the epidural anesthesia. Data were recorded and processed by means of a uterine contractility algorithm. The system is comprised of a multi-channel surface electromyogram (EMG) operative that senses electromyographic activity, a three-dimensional position sensor, and a personal computer providing data analysis and a graphical user interface. The data were sent offsite to an individual blinded to the clinical data for analysis. Fifteen women with low risk pregnancies participated in the study. The study revealed: (1) cervical dilation prior to administration of the epidural was 4.0 + 0.3 cm, whereas the second evaluation within one hour after placement of epidural was 6.0 + 0.6 cm. The difference between the first and second evaluations was significant, p=0.001. The study also revealed: (2) comparable measurements of electrical uterine activity between the initial and second evaluation (467±89 vs. 506±123) and (3) a positive association was found between the pre and post of electrical uterine activity measurements (r=0.47, p=0.05) Our data suggests that epidural anesthesia during the active phase of labor does not affect the electrical uterine activity.

to utilize non-invasive transabdominal uterine EMG monitoring via myometrial electrical activity in order to differentiate between spontaneous and abnormal labor. In a prospective double-blind study, electrical uterine myography (EUM) was measured in 63 women in active labor. Patients were classified into spontaneous or abnormal labor (based on Friedman′s labor curve). EUM, pitocin dose, and cervical characteristics were measured for 20 minutes at diagnosis and at two-hour intervals thereafter. The EUM system is comprised of a multi-channel surface electromyogram operative that senses electromyographic activity, a three-dimensional position sensor, and a personal computer. Data were sent for analysis offsite to an individual blinded to the clinical data. Sixty-three patients participated in the study (37 with abnormal labor and 26 controls). The study revealed: (1) during longitudinal analysis of patients with labor abnormalities in active phase, the electrical uterine activity increased after the administration of pitocin (480.9 ± 122 vs. 580.9 ± 123; p=0.0008); (2) the uterine electrical activity increased during active phase in spontaneous laboring patients (RMS1: 464.5 ± 112; RMS2: 509.1 ± 121 RMS3: 532.8 ± 118.7, p=0.04); (3) analysis of the electrical uterine activity of patients in spontaneous labor vs. those receiving pitocin augmentation was non significant (509.1 ± 121 vs. 513.8 ± 117; 532.8 ± 118 vs. 551.3 ± 114, respectively); (4) evaluation of the cervix at 6 and 8 cm showed significant increase in the dose of pitocin (7 vs. 10, p value 0.02) with similar electrical uterine activity (RMS 580.9 ± 37.0 vs. 572.5 ± 41.8). Our data suggests comparable electrical uterine activity occurs in both spontaneous and augmented laboring patients. However, our data further suggests that similar uterine activity in these patients can be achieved with lower doses of pitocin.

Several studies have supported the validity of diagnosing gestational diabetes (GDM) based on one abnormal value on the glucose tolerance test (GTT). The purpose of this study was to determine whether it matters which one of the four GTT values is abnormal. From 01/05-06/07, 412 women with GDM were managed at our Diabetes in Pregnancy Center. Following a positive glucose challenge test (≥130mg/dL), GDM was diagnosed based on one or more abnormal GTT values using Carpenter and Coustan criteria. Women followed dietary instructions and self monitored blood glucose values 7 times a day. If good glycemic control (mean glucose ≤105mg/dL) was not achieved within 1-2 weeks, glyburide therapy was begun.Insulin was used when glyburide treatment failed or was contraindicated. Women were followed every 1-2 weeks and meter values were downloaded and analyzed using meter-specific software. Chi square and ANOVA were used for statistical analysis. 88 of 412 women had 1 abnormal GTT value and are grouped in the table based on which of the 4 values was abnormal. Mean glucose area under the curve during GTT (AUC), mean glucose after initial diet therapy and during the last 2 weeks of pregnancy, and percent glucose values within targets were similar in all 4 groups.Tabled 1Abnormal valueFasting1-hour2-hour3-hourn533419GTT AUC386 ± 40413 ± 29423 ± 27407 ± 20Initial glucose108 ± 1396 ± 1098 ± 1297 ± 2Final glucose99 ± 1095 ± 1096 ± 1093 ± 5Good control80%91%86%100%values within targets16 ± 9%14 ± 11%16 ± 12%11 ± 5%Glyburide/insulin100%33%29%22% Open table in a new tab When the diagnosis of GDM is based on one abnormal GTT value, it does not matter which of the 4 values is abnormal.