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

257 Does maternal BMI modify the beneficial effects ofreatment in women with mild gestational diabetes?rian Casey1

for the Eunice Kennedy Shriver National Institute of Childealth and Human Development Maternal-Fetaledicine Units Network, Bethesda, Maryland

BJECTIVE: To determine whether maternal BMI modifies the benefi-ial effects of treatment on umbilical cord c-peptide levels and fetalrowth (LGA birthweight, and neonatal fat mass) in women with mildestational diabetes.TUDY DESIGN: This is a secondary analysis of a multicenter random-zed treatment trial of women with mild gestational diabetes, 92 % ofhich received diet therapy alone. Outcomes of interest were elevatedmbilical cord c-peptide levels (�90th %tile, 1.77 ng/mL), LGAirthweight (�90th %tile), and neonatal fat mass (g). For the pur-oses of this analysis women were grouped into five categories accord-

ng to BMI at enrollment and outcomes were analyzed according toreatment group assignment (treatment vs. control).ESULTS: A total of 958 women were enrolled (485 treated and 473ontrols). BMI groups were � 25 (N�143, 15%); 25 - � 30 (N�368,8%); 30 - � 35 (N�304, 32%); 35 - � 40 (N�104, 11%); and 40N�39, 4%) . Maternal BMI at enrollment was not related to umbil-cal cord c-peptide levels. However, treatment was associated witheduction in both LGA birthweight and neonatal fat mass in womenith BMI values in the middle three groups. Neither measure of excess

etal growth was related to treatment at the extremes of maternal BMIFigure).

ONCLUSION: The beneficial effect on fetal growth of treatment ofomen with mild gestational diabetes was not apparent in normaleight (BMI � 25) and very obese (BMI 40) women.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.272

258 Continous gluose monitoring of pregananciesith idiopathic polyhydramniosassandra Henderson1, Piro Koci2, Heynelda Marcano Vasquez3

Montefiore North Divsion Medical Center and New York Medical College,epartment of Obstetrics and Gynecology, and Women’s Health, Bronx,ew York, 2Monterfiore North Division Medical Center and New Yorkedical College, Department of Obstetrics and Gynecology,

nd Women’s Health, Bronx, New York, 3Montefiore Northivsion Medical Center, Department of Obstetrics andynecology. and Women’s Health, Bronx, New YorkBJECTIVE: To evaluate maternal glycemic status, 72 hour continuouslucose monitoring (CGMS) was employed in four pregnancies com-licated by idiopathic polyhydramnios.TUDY DESIGN: CGMS was used in four cases of idiopathic polyhy-ramnios. MiniMed CGMS by Medtronic for up to seventy-two con-inuous hours. MiniMed CGMS uses a glucose oxidase-based sensoro measure extracellular fluid glucose. It is placed into the subcutane-us tissue of the anterior abdominal wall using a spring-loaded devisethe Senserter). Glucose oxidase catalyzes glucose oxidation in the

nterstitial fluid. The devise reports average values every 5 minutes. 0

Supplemen

he sensor results for the Type 1 diabetic were calibrated against si-ultaneously obtained samples for self-monitoring glycemic control

SMBG) with glucose meter assessment of interstitial glucose fromngerstick blood samples. Each graph was used to determine the pres-nce of glycemic excursions and mean plama glucose values.ESULTS: Previously, unidentified maternal hyperglycemic patternsere documented in all four cases of idiopathic polyhydramnios. Oneoman had a normal OGTT, while 2 had an OGTT with one abnor-al value. The third gravida with Type 1 diabetes had a normal mean

lasma glucose value of �110 mg/dl., but had wide glycemic excur-ions ranging from 45 to 200 mg/dl.ONCLUSION: CGMS documented the presence of previously uniden-ified maternal hyperglycemia patterns in 4 pregnancies complicatedy idiopathic polyhydramnios. While the OGTT is sensitive, in ordero maintain a clinically acceptable specificity, this diagnositic test mayot identify a group of women with mild glucose intolerance. Studiesith greater power than that of the 2008 Siegmound trial may dem-nstrate that the glycemic excursions we identified are variations oformal preganancy metabolism. Alternately, our data may describe aoint on the continuum between normal glucose tolerance and glu-ose intolerance, warranting further investigation.002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.273

259 Glycemic characteristics of women treated forild gestational diabetes and perinatal outcomeseleste Durnwald1

for the Eunice Kennedy Shriver National Institute of Childealth and Human Development Maternal Fetaledicine Units Network, Bethesda, Maryland

BJECTIVE: To determine the association between fasting and 2 hourostprandial blood glucose levels and perinatal outcomes in womenith mild gestational diabetes (GDM) receiving dietary treatment.TUDY DESIGN: A secondary analysis of a multicenter randomizedreatment trial of mild GDM. Women with GDM (abnormal OGTT)nd a fasting glucose �95mg/dL who received dietary treatment with-ut the need for insulin were included. Fasting and 2 hour postpran-ial (PP) glucoses were recorded with memory based reflectanceeters. Median glucose levels were analyzed in 2-week intervals and

hange over time (slope) for each patient was calculated. Regressionnalyses were performed to determine the relationship betweenedian fasting and PP glucose values and neonatal fat mass, cord

lood C peptide, birthweight, large for gestational age (LGA) andacrosomia (�4000g).

ESULTS: Among 427 GDM women treated with diet alone, 23,978asting, 22,566 PP breakfast, 22,782 PP lunch and 22,170 PP dinnerlucoses were recorded. Median fasting (p�0.0001), PP breakfastp�0.0001) and PP lunch (p�0.002) glucose values declined over thereatment period, but not PP dinner, p�0.94. Median fasting and PPreakfast, lunch and dinner glucoses for the first 2 weeks were 81, 95.5,01 and 104mg/dL, and for the entire treatment period were 80, 94, 99nd 105 mg/dL, respectively. Median fasting glucose values during therst 2 weeks of treatment were significantly associated with increasedeonatal fat mass (p�0.005), elevated C-peptide (p�0.03) and mac-osomia (p�0.03), after controlling for maternal age, race, parity,MI at enrollment, gestational age at enrollment and at delivery. Me-ian fasting levels were not associated with LGA (p�0.07) or birth-eight (p�0.06). Change over time in glucose levels (slopes), PP glu-

ose and gestational age at enrollment were not associated witherinatal outcomes.ONCLUSION: In women receiving dietary intervention alone for mildDM, only fasting glucose levels were associated with increased neo-atal fat mass, macrosomia and elevated C-peptide.

002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.274

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