Volume 185, Number 6 A m J Obstet Gynecol

48 DIFFERENTIAL EXPRESSION OF EMBRYONIC AND MATERNAL ACTIV- ITY DEPENDENT NEUROPROTECTIVE PROTEIN (ADNP) DURING DE- VELOPMENT SARAH POGGI t, JOY VINK 2, JOANNA HILL 2, DOUGLAS BRENNEMAN 2, ALBERT PINHASOV 3, ILLANA GOZE83, CATHERINE SPONG4; ]GeorgetOwn Univ, Ob/Gyn , Washington, DC; ~NICHD, NIH, SDMP LDN, Bethesda, MD; ~Tel Aviv Univ, Biochem, Tel Aviv; 4NICHD, NIH, SDMP, LDN & PPB, gethesda, MD

OBJECTIVE: Activity d e p e n d e n t neuroprotect ive prote in (ADNP) has been mapped to chromosome 7, potently enhances the survival of neurons, and has exhibited neuroprotective actions in neurodegenerative models. The ol~jective of this study was to investigate ADNP and its expression in embryonic nmuse development th roughout gestation.

STUDY DESIGN: The embryonic tissues (embryo, membrane /dec idna , placenta) from timed pregnant C57BI6/J mice were harvested at gestational days (GD) 6 through 18 (delivery occurs ~ GD 20). The samples were separated into embryo (after GD 7), m e m b r a n e / d e c i d u a and placenta (after GD 11). For the analysis of ADNP messenger RNA (mRNA), RNA was extracted using the SV Total RNA Isolation System (Promega). Five ug of total RNA from each sample was used for each reverse t ranscr ip t ion/polymerase chain reaction. lmmunohis tochemis t ry with anti-ADNP pept ide immunoglobu l in was per- formed on 20 um thick fixed sections of NIH Swiss embryonic day 9.5 mouse p regnan t uteri.

RESULTS: ADNP mRNA is present in embryonic tissues t h r o u g h o u t gestation. Embryonic ADNP mRNA has a tempora l pa t te rn with grea te r amounts present f~rom gestational day 10-16. Placental ADNP mRNA was strongly present on gestational days 11-17, with a decrease on day 18. Decidual ADNP mRNA was strongly present and within the dec idna of the day 9.5 p regnan t mouse uterus, inamunocytochentistry revealed ADNP-positive cells th roughout the decidua, including lymphocytes.

CONCLUSION: The presence of ADNP throughout pregnancy supports a developmental role for this protein. These data indicate both embryonic and maternal somves of ADNP dur ing the critical per iod of organogenesis.

50

SMFM Abstracts S91

REASSURANCE IN THE PRESENCE OF CHANGES IN INTRAPARTUM FETAL HEART RATE PATTERNS KEITH WILLIAMS l, FRANCE GALER- NEAU t, JYale University; Obstetrics and Gynecology, New Haven, CT

OBJECTIVE: To correlate changes in the in t r apa r tum electronic fetal heart rate patterns with the development of significant neonatal acidosis.

STUDY DESIGN: We identified fetuses at a gestational age of > 37 weeks who had at least 2 hours of continuous electronic fetal moni tor ing pr ior to delivery a n d umbilical ar tery cord gas analysis done at delivery. One investigator blinded to the cord gas outcome reviewed all tracings using the NICH guidelines for FHR moni tor ing . All pat ients with bradycard ia were removed f rom fu r the r analysis. The pat ients were p laced in six groups depending on the absence or presence of normal variability (amplitude > 5 beats) for at least 1 hour, combined with the absence of decelerations or the presence of variable or late decelerations. The relationship between changes in variability and the outcome variables of pH and Base Deficit in the six groups was assessed using ANOVA and a chi-squared test.

RESULTS: Patients with normal variability even in the presence of late decelerations or variable decelerations maintained an umbilical artery ph > 7.0 in over 97% of cases. In the presence of decreased variability (amplitude _< 5) tor at least an hour, the incidence of significant acidemia (ph < 7.0) ranged from (12-31%) (Table).

CONCLUSION: The most significant factors with continuous fetal moni tor ing to predict the development of significant acidosis is the presence of decreased variability, for at least one hour as a solitary abnormal f inding or in conjunct ion with late or variable decelerations. Urgen t delivery should be considered in these cases.

Table

N N N DEC DEC DEC VAR& VAR& VAR& VAR& VAR& VAR&

N O LATE VAR N O LATE VAR DECEL DECEL DECEL DECEL DECEL DECEL P

No 42 173 219 13 25 16 UAPH 7.24+.07 7.18+.07 7.18_+.08 7.07_+.2 7.1+.14 7.19_+.14 <.0O0 Base -3.62_+3.16 -6.17_+3.14 -6.24+3.6 -9.8_+.07 -9.57_+6.14 6.37_+5.07 <.000

deficit Pfi>7.O 0% 1.7% 2.4% 31% 25% 12.5% <,000 Ph<7.1 9.5% 13.2% 9.9% 37.5% 43.8% 18.8% <,000 BD<-16 0% 0% 9.2% 23.1% 25% 12.5% <.O00 BD<-12 2.4% 4.6% 5.5% 38.5% 32% 12.5% <.000

49 FOLATE LEVELS IN PREGNANT SMOKERS: AN IMPORTANT GENE EN- VIRONMENT INTERACTION SARAH MCDONALD 1, SHERRY PERKINS 2, CAROL ANN J O D O U I N 2, MARK WALKER3; iOttawa Hospital, Obstetrics, Gynecology and Newborn Care, Ottawa, Ontar io; 2Ottawa Hospital , Bio- chemistry, Ottawa, Ontario; ~University of Ottawa, Maternal Fetal Medicine, Ottawa, Ontar io

OBJECTIVE: The objective of tltis study was to determine if serum and red blond cell (rbc) fblate levels were decreased in p regnan t smokers and if total plasma homocysteine levels were elevated.

STUDY DESIGN: In this cross-sectional study, serum folate, rbc folate and homocyste ine concent ra t ions were measured in p r e g n a n t first and early second trimester smokers (cases) and non-smokers (controls). In addition, vitamin B12, a lbmnin, creatinine, cotinine, hematocr i t and MTHFR status were determined and compared between groups.

RESULTS: Smokers had significantly lower concentrat ions of serum folate (22.7 versus 29.4 nmol /L , P - .001), and lower concentrations of rbc tblate (766 versus 900 n m o l / L , P = .038) than non-smokers. Dietary folate con- centrations were not significantly different between smokers and non-smokers. Homocysteine levels were also not significantly different between the groups. For each genotype of MTHFR, lower levels of serum folate were observed in smokers, with the lowest folate levels seen in homozygous MTHFR 677TT (18.6 n m o l / L in smokers versus 24.2 n m o l / L in non-smokers).

CONCLUSION: Both serum folate and rbc folate concent ra t ions are lower in pregnant smokers than non-smokers, while homocysteine levels are not significantly different. There is an impor tan t gene envi ronment inter- action between MTHFR gene activity and tobacco exposure on sermn folate levels. Lower levels of serum folate may account for the higher rate of mis- carriage, stillbirth, placental abrnp t ion , mad fetal anomal ies observed in smokers. Pregnant smokers may benefit f rom higher doses of periconceptual tblic acid.

51 INTRAUTERINE PRESSURE CATHETERS (IUPC) AND THE RISK OF EXTRA-OVULAR PLACEMENT AND RESULTANT PLACENTAL SEPARA- TION ANTHONY SCISCIONE 1, ANN RHEE 2, ADAM DUHL 3, MARJORIE POLLOCK 4, MATTHEW HOFFMAN 2, GARRETT COLMORGEN2: tNewark, DE; 2Christiana Hospital, Newark, DE; 3Johns Hopkins Medical Institution, Baltimore, MD; 4Christiana Hosp, Newark, DE

OBJECTIVE: Reports bare f o u n d a possible association between the placement of u-ansducer tipped (TT) IUPCs and the occurrence of placental abmpt ion. Stilfimss and tip characteristics of TT IUPCs may increase the risk of extra-ovular (between the amniotic membranes and uterus) placement. We sought to determine the rate of extra-ovular placement, if placental separation results from extra-ovular p lacement and if catbeters with different design characteristics affect the rate of extra-ovular placement.

STUDY DESIGN: A randont ized trial compar ing a TT IUPC to an air coupled (AC) IUPC was conducted. Women were eligible if their physician decided to place an IUPC. If a cesarean delivery was performed, the IUPC was left in place and the position documented. Outcome variables included extra- ovular p lacement , placental abrup t ion , difficulty in IUPC p lacement and bleeding on placement. Demographic characteristics and potential confounding variables were recorded.

RESULTS: There were 237 patients entered, 105 (44.3%) had a Cesarean delivery, with 41 in the AC IUPC group mad 64 in the TT IUPC group. There was no significant dif ference in materna l age, gestational age, gravidity, dura t ion of rup tu re of membranes , bir thweight , Apgar scores, cord pH, cocaine use, tobacco use, oxytocin use, catheter renaoval due to poor function or difficulty in placement . The TT IUPC g roup was more likely to have bleeding after insertion (22.8% vs. 9.3%; P = .02). Extra-ovular placement was significantly higher in the TT IUPC g roup (12,,5% vs. 2.4%; P= ,03). Three TT IUPCs were found in the placenta with evidence of placental separation in two. Cesarean delivery was more likely in the TT IUPC group (52.6% vs. 35.3%; P = .006).

CONCLUSION: The rate of extra-ovular IUPC placement is 8.4%. TT IUPCs are more likely to be placed extra-ovularly and may be associated with placental separation. An increased rate in Cesarean delivery in the TT IUPC group may be due to the higher rate of extra-ovular placement.