Larisa Yedigarova

Alteration of endothelial function markers in women with gestational diabetes and their fetuses.

Objective: We tested the hypothesis that women with gestational diabetes mellitus (GDM) and their fetuses would demonstrate alterations in markers of endothelial nitric oxide synthase (eNOS) uncoupling, oxidative stress, and endothelial dysfunction and these changes would correlate with the levels of hyperglycemia through a pilot observational case-control study of women with GDM and their fetuses. Methods: Levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), C-reactive protein (CRP), nitric oxide (NO), eNOS, p22-phox, and SOD gene expression, and endothelial progenitor cells (EPC) counts in both maternal and cord blood were measured at the time of delivery in women with and without GDM. Results: We demonstrated the presence of decreased maternal circulating EPC counts, increased soluble adhesion molecules in maternal blood, decreased SOD expression in both maternal and cord blood and increased eNOS expression in both maternal and cord blood in women with GDM. Conclusions: These data suggest that the molecular mechanisms behind oxidative stress in women with GDM and their fetuses appear similar to those hypothesized for non-pregnant adults with type 2 diabetes mellitus (DM).

Role of low placental share in twin–twin transfusion syndrome complicated by intrauterine growth restriction

OBJECTIVES Prior studies have demonstrated that donor twin survival following treatment of twin-twin transfusion syndrome (TTTS) was highly associated with donor intrauterine growth restriction (IUGR). Here, we hypothesized that donor IUGR may be attributed in part to low placental share. STUDY DESIGN The study population consisted of all patients who underwent laser treatment for TTTS at a single institution between 2006-2010. Only those pregnancies with dual survival at birth were included so that placental share information could be interpreted. We examined the relationships between Quintero Stage (with separate analysis of Stage III patients with critically abnormal donor Doppler findings) and low placental share (defined as ≤ 30%) with IUGR (<10th percentile) using chi-square analysis and multivariable logistic regression modeling. RESULTS Of 210 patients treated, 159 (75.7%) had dual survivors at birth. Of these, placental share was documented in 90 cases (56.6%). Twenty-seven (30.0%) had low placental share, and 37 (41.1%) had IUGR. IUGR was associated with low placental share (63.0% vs. 31.7%, P = 0.0116). IUGR was also associated with Stage III patients (57.4% vs. 23.3%, P = 0.0021), and in particular with Stage III patients with donor involvement (77.8% vs. 25.4%, P < 0.0001). In logistic regression modeling, both low placental share and Stage III with donor involvement were independent risk factors for IUGR (OR = 3.5 [1.2-10.3], P = 0.0206, and OR = 10.1 [3.3-30.6], P < 0.0001, respectively). CONCLUSIONS Donor IUGR in TTTS pregnancies appears to be associated, in part, with low placental share.

Prevalence of Noncardiac Structural Anomalies in Twin-Twin Transfusion Syndrome

Compared to singleton pregnancies, monochorionic twins have increased rates of perinatal morbidity and mortality, believed due in part to both twin‐twin transfusion syndrome and an increased risk of congenital anomalies. Here we describe the prevalence of noncardiac structural anomalies in monochorionic twins with twin‐twin transfusion syndrome who underwent laser surgery.

One-hour post-glucola results and pre-pregnancy body mass index are associated with the need for insulin therapy in women with gestational diabetes

Objective. The purpose of this study was to analyze the relationship of 1-h post-glucola (PG) screening results and the need for insulin therapy in women with gestational diabetes (GDM). Methods. The study group was comprised of women with GDM treated at a single institution during calendar years 2000–2004. Women with singleton, term (≥37 weeks gestation), liveborn fetuses were included. The association of 1-h PG results and other perinatal risk factors to the need for subsequent insulin therapy was analyzed using multivariable logistic regression models. Results. Of the 1451 women were included in the analysis, 18.1% required insulin treatment. The mean 1-h PG result was 170.0 ± 26.1 mg/dl (range 140–414 mg/dl). We determined that a 1-h PG ≥ 190 mg/dl (p < 0.0001), an obese body mass index (BMI) (p < 0.0001), an overweight BMI (p = 0.0019), prior GDM (p = 0.0019), and prior macrosomia (p = 0.0210) were each highly associated with the need for subsequent insulin therapy during the pregnancy. Conclusions. A 1-h PG ≥ 190 mg/dl was strongly associated with the need for insulin therapy in women with GDM. These data may be helpful in counseling and managing women with GDM.

OP15.05: Spontaneous intertwin dividing membranes rupture and membranes detachment in twin–twin transfusion syndrome

Results: 438 consecutive FFTS cases were treated at 15 to 26 weeks. PABS developed in eight cases (1.8%). The affected twin was always the former recipient. The diagnosis was made prenatally in two of eight cases (25%). All cases survived the perinatal period. PABS affected fetal leg, arm or foot. In five (62.5%) and seven (87.5%) cases, PABS occurred following premature rupture of membranes and intrauterine demise of the donor, respectively. No maternal, fetal or peri-operative risk factor could be identified. Conclusions: This complication is related to invasive procedure and is probably different in the physiopathology from the intrinsic malformative theory, suggesting that the anomalies and the fibrous bands have a common origin, caused by an anomaly of the developing germinal disc of the early embryo. The sequence of events in our series involved rupture of the amnion (5/8), fetal demise of the donor after laser fetoscopy (7/8) and prematurity (7/8). The latter is consistent with a particular role of membranes in this condition. Awareness and targeted serial ultrasound evaluation in this high-risk group may improve prenatal diagnosis, counseling and management of PABS following FLS.

OP24.05: Management of high-order multiples complicated by TRAP sequence

Objectives: To describe early changes in fetal cardiac function after laser treatment in severe twin–twin transfusion syndrome (TTTS). Methods: A prospective study was conducted over a fivemonth period. Cardiac function was assessed in 49 consecutive monochorionic pregnancies presenting with severe TTTS and referred for fetoscopic selective laser coagulation (FSLC) of placental anastomoses as first-line treatment. Echocardiography was performed on admission and after laser treatment (median = 1 day, IQR = 1–3). The studied parameters included cardiac output, myocardial performance index, shortening fraction (SF), and heart dimensions. Results: Median gestational age was 21 weeks (IQR = 19–23). Distribution across Quintero stages was as follow: 32.7%, 18.4%, 46.9% and 2.0% for stages 1, 2, 3 and 4 respectively. Cardiac output significantly increased after laser treatment in both donor (+33%) and recipient twins (+24%). In the recipient twin, a significant increase in LV SF was also found. The increase in cardiac output was not significantly correlated with Quintero stage, the volume of amniotic fluid drained, or gestational age. Conclusions: As early as 24 h after laser treatment, a significant increase in systolic function was found in both twins. These changes seem to be unrelated to initial severity of the syndrome.