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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 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