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DIABETES, LABOR, ULTRASOUND-IMAGING

Abstracts 237 – 386

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237 A short interpregnancy interval decreases the riskf gestational diabetes in the subsequent pregnancy

Allison Bryant1, Erin Madden2

1Massachusetts General Hospital, Boston, MA, 2NCIRE, San Francisco, CAOBJECTIVE: There has been a suggestion that shorter interpregnancyntervals (IPI) are associated with a decreased risk of gestational dia-etes (GDM) in later pregnancies. We hoped to test this hypothesis inlarge, multiethnic cohort of women with varying a priori risks ofDM.

STUDY DESIGN: A retrospective cohort study was conducted using datarom vital statistics (birth, infant and fetal death) records for all birthsn California between 1999 and 2004 linked with hospital dischargeata. For women with a first birth in 1999-2000 and a second birth byhe end of 2004, we examined the risk of GDM in the later pregnancy,s defined by a hospital discharge diagnosis ICD-9 code of 648.x. Wereated multivariable logistic regression models to adjust for relevantonfounders, including a diagnosis of GDM in the first pregnancy.

RESULTS: Of 190,409 of women studied, 7,592 (4.0%) carried a diag-osis of GDM. We created models adjusted for characteristics such asge, race, insurance, and for pregnancy characteristics such as mode ofelivery, birth weight, and pregnancy complications including GDM

n the first pregnancy. An IPI of shorter than 18 months was associatedith a reduction in the odds of a diagnosis of GDM in the secondregnancy (AOR 0.70, p�0.001). There were statistically significantifferences in the reduction in risk by maternal race and by the occur-ence of GDM in the first pregnancy. The reduction associated with anPI � 18 months was greatest for Hispanic (AOR 0.61, 95% CI [0.56,.66]) and Asian women (0.69 [0.61, 0.77]) as compared with Blacknd White women. Women with no prior history of GDM and a shortPI had an adjusted odds of GDM in the subsequent pregnancy of 0.670.63, 0.71]), lower than that for women with GDM in the first preg-ancy (0.80 [072, 0.90]).

CONCLUSIONS: An interpregnancy interval of �18 months appearsprotective against gestational diabetes in a subsequent pregnancy.This risk differs by maternal race and by history of GDM in the firstpregnancy. The protective effect, and variability between populations,may be explained by changes in body mass index.

238 Glucose response to corticosteroidherapy in pregnant women with diabetes

Ambica Garg1, Jerrie Refuerzo1, Barbara Rech1,usan Ramin1, Alex Vidaeff1, Sean Blackwell1

1University of Texas Health Science Center at Houston, Houston, TXOBJECTIVE: To compare the timing, duration and severity of hypergly-emia after corticosteroid administration in women with diabetesellitus (DM) compared to those without DM in pregnancy.

STUDY DESIGN: A prospective, observational study was conducted inregnant women with insulin-requiring DM who received corticoste-oid therapy for the purpose of accelerating fetal lung maturationetween 24-34 weeks. Women in active preterm labor and with mul-iple gestations were excluded. A control group was comprised ofregnant women without DM who also received corticosteroids.ourly glucose levels were measured subcutaneously with the Dex-

om Seven System continuous glucose monitor beginning after therst dose of corticosteroid and up to a maximum of 7 days. Cortico-teroid treatment was administered at hour 0 and 24. Median glucoseevels were calculated over 4 hour intervals of time. The primary out-ome was the time point of blood glucose elevation of at least 15%

bove baseline. Other outcomes compared between groups were the

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duration (length in time) and severity (percentage above baseline glu-cose) of such glucose elevations.RESULTS: Nine pregnant women participated in this study (6 with DMnd 3 without DM). In those with DM, the average maternal age was6.7 � 7.3 years, gestational age at corticosteroid treatment 31.5 weeksrange 30-34), body mass index 28.8 kg/m2 (24.9-41.9) and hemoglo-in A1C 6.7% (6.3-7.7). These values were similar in the controlroup. Elevations of glucose levels at least 15% above baseline oc-urred at hour 20, 44 and 68 in both groups and lasted for only 4 hoursfigure). In women with DM, glucose levels increased 33-48% aboveaseline in response to corticosteroids, whereas in those without DM,lucose levels rose 16-33%.

CONCLUSIONS: Short, discrete episodes of hyperglycemia occur in re-ponse to corticosteroid therapy for fetal maturation. The severity ofyperglycemia is greater in women with DM compared to those with-ut DM.

239 First trimester maternal vitamin D statusnd the risk for gestational diabetes mellitus

Arthur Baker1, Sina Haeri1, Carlos Camargo2,lison M Stuebe1, Kim Boggess1

1University of North Carolina at Chapel Hill, Chapel Hill,C, 2Massachusetts General Hospital, Boston, MA

OBJECTIVE: Vitamin D deficiency in pregnancy is common and maylay a role in adverse pregnancy outcomes, such as gestational diabe-es mellitus. Vitamin D status correlates with insulin sensitivity andffects pancreatic beta cell function. Our objective was to assesshether first trimester maternal vitamin D deficiency is associatedith an elevated risk of gestational diabetes mellitus.

STUDY DESIGN: We conducted a nested case-control study in a cohortof 4,225 women. All women who delivered at the University of NorthCarolina-Chapel Hill between November 2004 and July 2009 and hadprovided blood at 11-14 weeks for routine genetic screening wereeligible. Sixty women with gestational diabetes mellitus by NationalDiabetes Data Group critieria were matched by race/ethnicity to 120women with normal glucose tolerance and uncomplicated term (�37weeks) birth. Banked maternal serum was used to measure maternal25-hydroxyvitamin D [25(OH)D] using liquid chromatography-tan-dem mass spectrometry. Vitamin D deficiency was defined as25(OH)D �50 nmol/L.RESULTS: Maternal demographics were similar between the groups.

he mean (SD) concentration of 25(OH)D in this study was 91 � 28nmol/L. The prevalence of first trimester maternal 25(OH)D defi-ciency was low both among women with gestational diabetes mellitusand uncomplicated term birth (8% vs. 7%, respectively; P�0.95). Theprevalence of vitamin D sufficiency (defined as 25(OH)D �75

nmol/L) was high in both groups (73%).

ent to JANUARY 2011 American Journal of Obstetrics & Gynecology S103

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Poster Session II Diabetes, Labor, Ultrasound-Imaging www.AJOG.org

CONCLUSIONS: In a cohort of women with a high prevalence of optimalevels of serum 25(OH)D, vitamin D status was not associated withestational diabetes mellitus. Studies in pregnant populations whereitamin D deficiency is more prevalent are needed to determine theole of vitamin D in gestational diabetes mellitus.

240 A significant higher rate of omental macrophagesnfiltration in gestational diabetes mellitus pregnancies

Avi Harlev1, Assaf Rudich2, Nava Bashan2, Eyalheiner1, Ruth Shaco-Levy3, Barak Aricha-Tamir4,ania Tarnovscki2, Arnon Wiznitzer1

1Soroka University Medical Center, Beer Sheva, 2Department of Clinicaliochemistry, The National Institute of Biotechnology in the, Beerheva, 3Department of Pathology, Faculty of Health Sciences,

Beer Sheva, 4Soroka University Medical Center, Beer-ShevaOBJECTIVE: To assess macropahage infiltration to omental and subcu-aneous adipose tissue in pregnancies of women with gestational dia-etes mellitus (GDM) as compared with normal pregnancies.

STUDY DESIGN: Paired omental and abdominal subcutaneous (SC) fatsamples were prospectively collected from 11 GDM pregnancies and20 women with normal pregnancies during cesarean delivery (CD).The tissues were stained for CD68, using standard immunohisto-chemistry methods. Macrophages were counted by a certified pathol-ogist blinded to the sample data. Macrophage count is presented as thenumber per 100 adipocytes (percent macrophages). Stratified analysiswas performed using a multiple logistic regression model to controlfor confounders.RESULTS: A significant higher rate of omental macrophages was foundn the GDM group as compared with non-GDM pregnancies (5.05 �.10 vs. 0.65 � 1.02, p�0.038). Nevertheless, no significant differencen the SC tissue macrophage infiltration was noted between the groups1.30 � 2.44 vs. 0.47 � 1.17, p�0.310). There was a significant higher

rate of macrophage infiltration to the omental fat as compared to SCinfiltration in patients with GDM (5.05� 6.10 vs. 1.30 � 2.44,p�0.030). While comparing omental to SC macrophage infiltrationin women without GDM, no significant differences were found (0.65� 1.02 vs. 0.47 � 1.17, p�0.346; figure). A positive correlation wasnoted between omental macrophage infiltration and blood fastinginsulin levels (r�0.381, p�0.031). While controlling for gestationalage (in weeks), using a multiple logistic regression model, the associ-ation between macrophage infiltration and GDM remained signifi-cant (OR�1.44, 95% CI 1.02-2.03, P�0.037).CONCLUSIONS: A significant higher rate of omental macrophages infil-ration is noted in gestational diabetes mellitus pregnancies. Prefer-ntial macrophage infiltration into omental fat is a general phenom-non exaggerated by central obesity, potentially linking GDM withncreased risk of future diabetes and coronary heart disease.

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S104 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

241 Predicting failure of treatmentn GDM: glyburide vs insulin

Barak Rosenn1, Oded Langer1, Lois Brustman1

1St. Luke’s-Roosevelt Hospital Center, New York, NYOBJECTIVE: Approximately 20% of women with gestational diabetesGDM) who are treated with glyburide fail to achieve good glycemicontrol and various studies have identified factors associated withreatment failure. We hypothesized that factors associated with failuref glyburide therapy are similar to those associated with failure of

nsulin therapy in GDM.STUDY DESIGN: Women with GDM who began therapy with glyburideor insulin before 34 weeks gestation were included in this study. Pa-tients were instructed to self-measure glucose levels 7 times a day andmedication dosages were adjusted every week, as needed, to attaingood glycemic control. Failure of treatment was defined as a meanblood glucose �105mg/dL. Multiple logistic regression was used toidentify factors associated with treatment failure in each group. Sig-nificance was set at �.05.RESULTS: Of the 423 women included in the study, 232 (55%) werereated with glyburide and 69% of these achieved good glycemic con-rol. 191 (45%) were treated with insulin and 59% of these achievedood control. In both groups, the fasting glucose value on the 3-hourlucose tolerance test (GTT) and the dosage of medication (glyburider insulin) were the most significant factors associated with treatmentailure (higher fasting glucose and higher dosage � higher risk ofailure). Failure was also associated with maternal age and parity in thelyburide group, and with gestational age at diagnosis of GDM in thensulin group. Maternal BMI, maternal race and the 1, 2, or 3-houralues on the GTT were not associated with treatment failure.

CONCLUSIONS: Severity of diabetes and medication dosage are theost significant factors associated with failure of treatment in GDM,

egardless of the medication used. We speculate that the hesitance ofare providers to increase medication dosages appropriately may fur-her contribute to treatment failure.

242 Does excessive gestational weight gain increase theisk for adverse perinatal outcomes in diabetic women?

Benjamin Kase1, Clint Cormier2, Maria Hutchinson1,usan Ramin1, Manju Monga1, Sean Blackwell1

1University of Texas Health Science Center at Houston, Houston,X, 2LSU Health Sciences Center, Shreveport, LA

OBJECTIVE: Excessive gestational weight gain (GWG) increases theisk for gestational diabetes, fetal macrosomia, and cesarean deliveryCD) in non-diabetic women. However, there is a paucity of dataegarding GWG in diabetic pregnancies. Our purpose was to deter-ine the frequency of excessive GWG and its impact on perinatal

utcomes in women with gestational (GDM) and pre-gestationalM.

STUDY DESIGN: Retrospective cohort study of women with GDM andpre-gestational DM delivered at a tertiary care hospital between 6/01/2007-5/31/2008. Total GWG was determined for each woman andcategorized as excessive if it exceeded the 2009 IOM recommenda-tions based on maternal pre-pregnancy BMI. Clinical characteristicsand perinatal outcomes were compared for women based on presenceor absence of excessive GWG. Women with GDM and pre-gestationalDM were analyzed separately. A composite adverse perinatal outcome(APO) was defined as occurring when there was preterm birth� 34weeks gestation, severe preeclampsia, shoulder dystocia, or need forneonatal respiratory support.RESULTS: There were 155 women who met study criteria and hadvailable data. There were no difference in the rate of excessive GWGetween GDM and pre-gestational DM (44.4% vs.38.5% p� 0.51).here was also no difference in the rate of excessive GWG based onhite’s classification (p� 0.17). Perinatal outcomes were not differ-

nt based on presence of excessive GWG for GDM or pre-gestational

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