364 LOW BIRTH WEIGHT PATTERNS: ASSESSING TELEMEDICAL ACCESSINEQUALITY IN ARKANSAS DAVID BRITT1, BECKY BUTLER2, ALANAHULEN2, JUDITH MCGHEE3, HELEN KAY2, CURTIS LOWERY2, 1DrexelUniversity School of Medicine, Department of Obstetrics and Gynecology,Philadelphia, PA 2University of Arkansas for Medical Sciences, Obstetrics andGynecology, Little Rock, AR 3Department of Human Services, MedicalServices Division, Little Rock, AR

OBJECTIVE: To assess statewide needs for local placement of compressedvideonetworks to increasepatientaccessibility tohigh-riskobstetrical interventions.

STUDY DESIGN: Data were gathered for the 75 Arkansas countiesregarding the average number of low birth weight (LBW) babies for 1997-1999, the size of minority populations, number of Medicaid-eligible persons,and total population size. Multiple linear regression was used to analyze the dataand was supplemented by the use of box plots to assess patterns of county spreadaround the median for the five health regions in the state. Qualitativecomparative analysis was used as a second analytic technique because of themulticollinearity in the data set.

RESULTS: With total population controlled, LBW babies were considerablymore likely to be born in counties with larger black (beta = .26, sig. < .001),Hispanic (beta = .18, sig. < .001), and Medicaid-eligible (B = .67, sig. < .001)populations. For the overall regression equation, the adjusted R2 = .98,significant at the .001 level. Box plot analysis of the spread around the medianrevealed several extreme outlying counties that supported the regressionanalysis results. The seven counties (10% of total) with the highest LBW rateaccounted for 43% of the total number of LBW babies from 1997-1999, whereasthe seven counties (10% of total) with the lowest LBW rate accounted for lessthan 2% of the total number. Six of the seven counties with the highest rate ofLBW have now been equipped with a telemedical site, while one site has beeninstalled in the region with the lowest rate LBW.

CONCLUSION: Antenatal/perinatal telemedical sites have been negoti-ated in areas where the need is greatest both in terms of immediate risk (LBWhistory) and presence of continuing risk factors associated with LBW risk(minority status and poverty).

365 NEURAL TUBE AND CARDIOVASCULAR DEFECTS IN INFANTS OFDIABETIC MOTHERS: DOES MATERNAL OBESITY INCREASE THERISK? DOROTHEA MOSTELLO1, SOPHEAK SRUN2, JANET TANG2,TERRY LEET2, 1Saint Louis University, Obstetrics, Gynecology and Women’sHealth, St. Louis, MO 2Saint Louis University, Community Health, St. Louis,MO

OBJECTIVE: To determine if maternal insulin-dependent diabetes (DM)and obesity act synergistically to increase the risks of neural tube defects (NTD)or cardiovascular defects (CVD) above the risks associated with each conditionalone.

STUDY DESIGN: We conducted a population-based cohort study usingMissouri birth and fetal death certificate data, linked to a registry that includesall birth defects detected during the first year of life. Data from 159,093 womenwho delivered singletons during 1993-1999 were analyzed using logisticregression.

RESULTS: Obesity (bodymass index$ 30), (n = 73,900), increased the riskof NTD (adjusted prevalence ratio [aPR] 1.7, 95% confidence interval [CI] 1.2,2.3) and CVD (aPR 1.2, CI 1.2, 1.3). DM (n = 1582) had an insignificant effecton NTD (aPR 1.4, CI 0.3, 5.8) but quadrupled the risk of CVD (aPR 4.0, CI 3.2,4.9), especially conotruncal and right heart defects. Risk for women with bothDM and obesity (n = 1310) was not increased over that for DM alone (aPR 4.2,CI 3.4, 5.2) for CVD; aPR for NTD was not calculable (small number).

CONCLUSION: Maternal DM is a strong risk factor for CVD. Maternalobesity alone is a risk factor for NTD and CVD but does not seem to increasefurther the risks of NTD or CVD associated with DM alone.

366 DELETERIOUS EFFECTS ARE FOUND IN PREGNANT WOMEN AD-DICTED TO COCAINE SULFATE (‘‘PASTA BASE’’) SMOKING DURINGPREGNANCY JORGE CARRILLO1, RAUL TAPIA2, ALEJANDRA CABEL-LOS2, PATRICIA MELLA2, ALVARO INSUNZA1, ENRIQUE PAIVA1, 1Hos-pital Padre Hurtado, Universidad del Desarrollo, Santiago, Chile 2HospitalPadre Hurtado, Santiago, Chile

OBJECTIVE: To determine the obstetric and neonatal impact of cocainesulfate smoking (an extract of coca mixed with water, kerosene, and sulfuricacid) during pregnancy.

STUDY DESIGN: Retrospective case-control study (1:3 ratio) of patientsself-reporting cocaine sulfate use (CSU; cases) between 11/1998 and 01/2003.The three deliveries registered after the cases at the Birth Registry database wereconsidered as control group (CG). Demographic, antenatal, intrapartum, andneonatal outcome data were extracted and compared.c2 and Fisher’s test andStudent’s t test were used as appropriate, with P < 0.05 considered significant.

RESULTS: 65 patients self-reported CSU. When compared with CG(n = 220), it was noted that CSU patients had lower socioeconomic status; weremore likely to have no pregnancy care (29.2% vs 1.4%; P < 0.05), to use othersubstances such as alcohol, tobacco, andmarijuana; and to have a higher rate ofseropositivity for syphilis (25.9% vs 1.85%; P < 0.05). As well, CSU patients weremore likely to have preterm births (18.4% vs 1.3%; P < 0.05) and a significantlyhigher rate of SGA newborns (44.6% vs 10.9%, P < 0.05). More admissions toneonatal unit (16.9% vs 6.3%; P: 0.05) were present in the offspring of CSUpatients.

CONCLUSION: Cocaine sulfate smoking during pregnancy is significantlyassociated with adverse maternal and neonatal outcomes. To prevent and toreduce these adverse outcomes, a targeted screening should be taken intoaccount for patients with this profile during antenatal visits and/or at themoment of labor and delivery. Prospective studies with this intervention shouldbe planned.

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Volume 189, Number 6Am J Obstet Gynecol

SMFM Abstracts S161

RACE IS NOT RELEVANT FOR BIRTHWEIGHT DISTRIBUTION WHENHEALTH INDICES ARE COMPARABLE ROGELIO GONZALEZ1, JYHNIEN1, RICARDO GOMEZ1, PAULA MERINO1, ALEJANDRA ETCHEGAR-AY1, MARIO CARSTENS1, LUIS MEDINA1, IVAN ROJAS1, PAOLA VIVIANI1,RENE CASTRO2, 1CEDIP, Sotero del Rıo Hospital, Puente Alto; PUniversidad Catolica de Chile, Santiago, Chile 2Ministerio de Salud,Santiago, Chile

OBJECTIVE: The World Health Organization (WHO) has established thata population-based curve should be used as birthweight standard (Williams etal). This study was designed to (a) create a birthweight curve based on a mostlyHispanic population, (b) assign perinatal risks according to birthweight, and (c)compare with the standard proposed by WHO.

STUDY DESIGN: A national birthweight-for-gestational age curve(smoothed) was constructed including all singleton deliveries that occurredin Chile from 1993 to 2000. Perinatal mortality was calculated for birthweightintervals. A comparison with an international standard (Williams’s curve) wasperformed.

RESULTS: A national curve was constructed with 2,055,879 singletondeliveries. During the year 2000 (246,930 deliveries), the perinatal mortality(31000 live births) according to percentile intervals of this curve was 118.8 (p2);41.3 (p2-5); 20.8 (p5-10); 11.9 (p10-25); 6.15 (p25-50); 4.79 (p50-75); 4.27 (p75-90); 5.26 (p90); and 10.17 (total). Comparing the 10th percentile of both curves(present and William’s) the median difference after 26 weeks was 42 g (2-77),See graph (Chilean, open squares; William’s, open triangles). Maternal,perinatal, and infant mortality were 18.7 (3100,000), 8.6 (31000), and 8.9(31000), respectively, for this period.

CONCLUSION: Perinatal mortality increased dramatically whenbirthweight fell below the 5th percentile for this population. Under comparableperinatal health indices, there are no differences between this predominantlyHispanic curve and the standard proposed by WHO.