265 Induction at term for women with gestationaldiabetes mellitus (GDM): safe for the motherbut questionable for the neonateMaayan Bas-Lando1, Naama Srebnik1, Arnon Samueloff1,Rivka Farkash2, Sorina Grisaru-Granovsky1

1Shaare Zedek MC, Affiliated to the Hebrew University Medical School,Obstetrics and Gynecology, Jerusalem, Israel, 2Shaare ZedekMC, Affiliated to the Hebrew University Medical School,Computerized Database Systems, Jerusalem, IsraelOBJECTIVE: Induction at term is considered the mainstream forwomen with GDM in order to decrease macrosomia related compli-cations. However, it is likely to increase the cesarean section (CS) rate.We aimed to evaluate the influence of this approach on the cesareansection rate.STUDY DESIGN: Cohort study of 73,800 births at a tertiary center, be-tween 2005-2011 based on computerized perinatal database. Thestudy group (Group 1) included all women with singleton, head pre-sentation, EFW �4,000 gms, for which a diagnosis of GDM was theindication for induction (38-41 wks). GDM diagnosis was based on allcriteria: National Diabetes Data Group, Carpenter & Coustan andOGTT 1 abnormal value. The control group (Group 2) included allhealthy women admitted for induction due to ruptured membranes atterm, normoglycemic (GCT �130mg/dl or normal OGTT). The mainoutcome was the CS rate whilst secondary measurements were mater-nal and neonatal outcomes. Statistics analyses were descriptive as wellas, univariate and multivariate comparisons OR (95%CI).RESULTS: We identified 240 women in Group 1 and 1690 in Group 2.Group 1 glycemic control (mean glucose 72 hrs (p�0.2 and 0.3 re-spectively).CONCLUSION: Induction at term for GDM is not associated with anyincrease in the maternal risks. Whether the risk of shoulder dystocia isaugmented by induction of labor in women with GDM should becarefully evaluated in future multicenter studies.

266 The risk of childhood obesity in toddleroffspring of gestational diabetic mothersMichelle Pham1, Katherine Brubaker2,Kimberly Pruett3, Aaron Caughey4

1Kaiser Permanante, OBGYN, Santa Clara, CA, 2Kaiser Permanente SantaClara, OBGYN, Santa Clara, CA, 3Kaiser Permanente Northern California,OBGYN, Santa Clara, CA, 4Oregon Health & Science University,Department of Obstetrics and Gynecology, Portland, OROBJECTIVE: The purpose of this study is to determine whether the chil-dren (ages 2-4 years) of gestational diabetic (GDM) mothers are atincreased risk for childhood obesity compared to the same aged chil-dren of non-gestational diabetics (non-GDM). Secondary outcome isto determine if there are associations between pre-pregnancy BMI,maternal weight gain, infant birthweight and ethnicity of GDM momsand childhood obesity.STUDY DESIGN: This was a retrospective case-control study of womenwith and without GDM and their respective term offspring who de-livered at a single institution between 2004 and 2007. Patients withvariables known to affect infant birth weight such as hypertensivedisorders, smoking, alcohol, and multiple gestation were excluded.Pre-pregnancy BMI, weight gain, demographics, birth weight, type ofGDM (A1 vs. A2) and follow up childhood BMI between 2-4 yearswere then collected. Childhood obesity (overweight/obese) was de-fined as a BMI �85th percentile or weight �90th percentile if heightunavailable. Dichotomous outcomes were analyzed with Chi squaretest.RESULTS: We identified 203 women/toddler pairs with GDM and 2148women/toddler pairs of non-GDM. BMI percentiles of toddlers be-tween GDM and non-GDM did not differ (mean 52.2 percentile vs.55.3 percentile, p � 0.204). The percent of overweight/obese toddlersin each group also did not differ (23.2% vs. 23.6%, p�0.90). Birth-weights of GDM infants tended to be lower than those of non-GDM

(3388 gm vs. 3448 gm, p � 0.076) although the GDM mothers weredelivered slightly earlier(39.4 weeks vs. 39.8 wks, p �0.0001) whichmight affect birth weight. Of interest, Asians were over represented inthe GDM group and whites were over represented in the non-GDMgroup (P�0.0001).CONCLUSION: These data were unable to detect a statistically significantdifference in the rate of childhood obesity in children born to GDM vs.non-GDM pregnancies. Whether this is due to glycemic control ofGDM or its effect on birthweight deserves further research attention.

267 The effect of Type 1 diabetes on mouse embryonicand neonatal cardiac function and structureNiamh Corrigan1, Derek Brazil2, Fionnuala McAuliffe3

1School of Medicine and Medical Science, UCD Conway Institute ofBiomolecular and Biomedical Science,University College Dublin, Dublin,Ireland, 2Centre for Vision and Vascular Science, School of Medicine,Dentistry and Biomedical Science, Queen’s University of Belfast,Belfast, United Kingdom, 3UCD Obstetrics and Gynaecology,School of Medicine and Medical Science, Dublin, IrelandOBJECTIVE: The purpose of our study was to examine the effect of Type1 diabetes on the structure and function of the fetal and neonatal heartusing a C57BL6/J mouse model.STUDY DESIGN: Type 1 diabetes was induced in female C57BL6/J miceusing Streptozotocin pre pregnancy. The study groups were dividedinto 3; a) Diabetic (fasting blood glucose (FBG) �11.2 mmol/l, n�24,b) Pre-diabetic FBG � 11.2 mmol/l, n�10, c) non-diabetic controls,n�10. Cardiac function and structure was assessed in embryonic(n�158 in total, 108 study, 50 control) and neonatal hearts (n�46 intotal, 18 study, 28 control) using a non-invasive high frequency ultra-sound biomicroscope at E10.5, E12.5, E14.5, E16.5 and E18.5 and at 1week of age. A cohort of E18.5 and 1 day old pup hearts underwenthistological examination (n�43 in total, 26 study, 17 control).RESULTS: Global cardiomyopathy in late gestation (E18.5) was evidentin the diabetic group compared to controls with increased interven-tricular septal (IVS) thickness (0.44mm �/� 0.019 vs 0.36mm �/�0.024 p � 0.05) and posterior cardiac wall thickness (0.38mm �/�0.011 vs 0.29mm �/� 0.015 p� 0.01) Isovolumetric relaxation timewas prolonged in the diabetic group from E12.5 to E16.5 but resolvedby E18.5 to control values. There was no difference in the IVS norposterior cardiac wall thickness in the one week old diabetic pupscompared to controls. The average weight of the E18.5 embryos dif-fered in the three groups (diabetic 0.84g �/� 0.05, pre-diabetic 1.07g�/� 0.02, controls 1.18g �/� 0.07 p � 0.05). Histological examina-tion at E18.5 demonstrated increased IVS thickness corrected forbody weight for the diabetic group when compared to controls (0.57�/� 0.02 vs 0.35 �/� 0.04, p � 0.01).CONCLUSION: Maternal hyperglycaemia resulted in significant cardiacimpairment and cardiomyopathy in the embryo. These data provideevidence for a fetal programming effect on the cardiovascular systemwhich despite some resolution in the neonatal period, could explainthe increased risk in later life of cardiovascular disease in offspring ofdiabetic pregnancy.

268 Early treatment without rescreening among womenwith a history of insulin requiring gestational diabetes(GDM) reduces the incidence of macrosomiaNicola Maher1, Fionnuala McAuliffe2, Michael Foley3

1National Maternity Hospital, Obstetrics and Gynaecology, Dublin, Ireland,2UCD Obstetrics and Gynaecology, School of Medicine and MedicalScience, Dublin, Ireland, 3UCD Obstetrics and Gynaecology,School of Medicine and Medical Science, Dublin, IrelandOBJECTIVE: In this center all women with a previous history of GDMare treated without rescreening from early pregnancy, commencingwith a low glycaemic diet and insulin if indicated. The objective was tosee if this practice reduced the incidence of macrosomia comparedwith the previous pregnancy. As only 70% will develop GDM in sub-sequent pregnancy the analysis was confined to women who then

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S130 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2012