237: A short interpregnancy interval decreases the risk of gestational diabetes in the subsequent...
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DIABETES, LABOR, ULTRASOUND-IMAGING Abstracts 237 – 386 237 A short interpregnancy interval decreases the risk of gestational diabetes in the subsequent pregnancy Allison Bryant 1 , Erin Madden 2 1 Massachusetts General Hospital, Boston, MA, 2 NCIRE, San Francisco, CA OBJECTIVE: There has been a suggestion that shorter interpregnancy intervals (IPI) are associated with a decreased risk of gestational dia- betes (GDM) in later pregnancies. We hoped to test this hypothesis in a large, multiethnic cohort of women with varying a priori risks of GDM. STUDY DESIGN: A retrospective cohort study was conducted using data from vital statistics (birth, infant and fetal death) records for all births in California between 1999 and 2004 linked with hospital discharge data. For women with a first birth in 1999-2000 and a second birth by the end of 2004, we examined the risk of GDM in the later pregnancy, as defined by a hospital discharge diagnosis ICD-9 code of 648.x. We created multivariable logistic regression models to adjust for relevant confounders, including a diagnosis of GDM in the first pregnancy. RESULTS: Of 190,409 of women studied, 7,592 (4.0%) carried a diag- nosis of GDM. We created models adjusted for characteristics such as age, race, insurance, and for pregnancy characteristics such as mode of delivery, birth weight, and pregnancy complications including GDM in the first pregnancy. An IPI of shorter than 18 months was associated with a reduction in the odds of a diagnosis of GDM in the second pregnancy (AOR 0.70, p0.001). There were statistically significant differences in the reduction in risk by maternal race and by the occur- rence of GDM in the first pregnancy. The reduction associated with an IPI 18 months was greatest for Hispanic (AOR 0.61, 95% CI [0.56, 0.66]) and Asian women (0.69 [0.61, 0.77]) as compared with Black and White women. Women with no prior history of GDM and a short IPI had an adjusted odds of GDM in the subsequent pregnancy of 0.67 [0.63, 0.71]), lower than that for women with GDM in the first preg- nancy (0.80 [072, 0.90]). CONCLUSIONS: An interpregnancy interval of 18 months appears protective against gestational diabetes in a subsequent pregnancy. This risk differs by maternal race and by history of GDM in the first pregnancy. The protective effect, and variability between populations, may be explained by changes in body mass index. 238 Glucose response to corticosteroid therapy in pregnant women with diabetes Ambica Garg 1 , Jerrie Refuerzo 1 , Barbara Rech 1 , Susan Ramin 1 , Alex Vidaeff 1 , Sean Blackwell 1 1 University of Texas Health Science Center at Houston, Houston, TX OBJECTIVE: To compare the timing, duration and severity of hypergly- cemia after corticosteroid administration in women with diabetes mellitus (DM) compared to those without DM in pregnancy. STUDY DESIGN: A prospective, observational study was conducted in pregnant women with insulin-requiring DM who received corticoste- roid therapy for the purpose of accelerating fetal lung maturation between 24-34 weeks. Women in active preterm labor and with mul- tiple gestations were excluded. A control group was comprised of pregnant women without DM who also received corticosteroids. Hourly glucose levels were measured subcutaneously with the Dex- com Seven System continuous glucose monitor beginning after the first dose of corticosteroid and up to a maximum of 7 days. Cortico- steroid treatment was administered at hour 0 and 24. Median glucose levels were calculated over 4 hour intervals of time. The primary out- come was the time point of blood glucose elevation of at least 15% above baseline. Other outcomes compared between groups were the 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 DM and 3 without DM). In those with DM, the average maternal age was 26.7 7.3 years, gestational age at corticosteroid treatment 31.5 weeks (range 30-34), body mass index 28.8 kg/m 2 (24.9-41.9) and hemoglo- bin A1C 6.7% (6.3-7.7). These values were similar in the control group. Elevations of glucose levels at least 15% above baseline oc- curred at hour 20, 44 and 68 in both groups and lasted for only 4 hours (figure). In women with DM, glucose levels increased 33-48% above baseline in response to corticosteroids, whereas in those without DM, glucose levels rose 16-33%. CONCLUSIONS: Short, discrete episodes of hyperglycemia occur in re- sponse to corticosteroid therapy for fetal maturation. The severity of hyperglycemia is greater in women with DM compared to those with- out DM. 239 First trimester maternal vitamin D status and the risk for gestational diabetes mellitus Arthur Baker 1 , Sina Haeri 1 , Carlos Camargo 2 , Alison M Stuebe 1 , Kim Boggess 1 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, 2 Massachusetts General Hospital, Boston, MA OBJECTIVE: Vitamin D deficiency in pregnancy is common and may play a role in adverse pregnancy outcomes, such as gestational diabe- tes mellitus. Vitamin D status correlates with insulin sensitivity and affects pancreatic beta cell function. Our objective was to assess whether first trimester maternal vitamin D deficiency is associated with an elevated risk of gestational diabetes mellitus. STUDY DESIGN: We conducted a nested case-control study in a cohort of 4,225 women. All women who delivered at the University of North Carolina-Chapel Hill between November 2004 and July 2009 and had provided blood at 11-14 weeks for routine genetic screening were eligible. Sixty women with gestational diabetes mellitus by National Diabetes Data Group critieria were matched by race/ethnicity to 120 women with normal glucose tolerance and uncomplicated term (37 weeks) birth. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D] using liquid chromatography-tan- dem mass spectrometry. Vitamin D deficiency was defined as 25(OH)D 50 nmol/L. RESULTS: Maternal demographics were similar between the groups. The mean (SD) concentration of 25(OH)D in this study was 91 28 nmol/L. The prevalence of first trimester maternal 25(OH)D defi- ciency was low both among women with gestational diabetes mellitus and uncomplicated term birth (8% vs. 7%, respectively; P0.95). The prevalence of vitamin D sufficiency (defined as 25(OH)D 75 nmol/L) was high in both groups (73%). Poster Session II www. AJOG.org Thursday, February 10, 2011 • 3:30 pm – 5:30 pm • Grand Ballroom, Hilton San Francisco Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology S103
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Transcript of 237: A short interpregnancy interval decreases the risk of gestational diabetes in the subsequent...
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Poster Session II www.AJOG.orgThursday, February 10, 2011 • 3:30 pm – 5:30 pm • Grand Ballroom, Hilton San Francisco
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 theSupplem
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
