353 DETERMINANTS OF NEONATAL HYPOGLYCEMIA IN WOMEN WITH TYPE II ANDGESTATIONAL DIABETES MELLITUS GLADYS RAMOS1, ALETHEA HANLEY1, JENNIFERAGUAYO2, CARRI WARSHAK1, THOMAS MOORE1, 1University of California, San Diego,San Diego, California, 2University of California, San Diego, California

OBJECTIVE: To determine the risk factors associated with neonatal hypoglyce-mia in neonates of mothers with Type II and gestational diabetes mellitus (GDM).

STUDY DESIGN: A retrospective study was performed evaluating neonates ofType II and GDM women treated with diet, glyburide and insulin. Maternal char-acteristics, glycemic control, and neonatal hypoglycemia were assessed. Statisticalmethods included bivariate analyses.

RESULTS: In 2001-2004, 259 mother and neonate pairs were identified. Sixty-eight (26%) were treated with diet, 110 (42%) with glyburide, and 81 (31%) withinsulin. The incidence of neonatal hypoglycemia (capillary blood sugar �45mg/dL) was 20% (51/259). The incidence was significantly lower in the diet treatedgroup (3%, 2/68, p�0.001) when compared to the glyburide (24%, 26/110) andinsulin (28%, 23/81) groups. The rate of neonatal hypoglycemia between the gly-buride and insulin groups did not vary with diabetes type (type II diabetics (35%)vs. A2 GDM (22%), p�0.07) or medication type (glyburide (24%) vs. insulin(28%), p�0.50). Mean fasting and postprandial values at 36 weeks (fasting90.3�15 vs. 92.1�14, p�0.30 and postprandial 13.7�22 vs. 130.7�26, p�0.11)and during the last week of pregnancy (fasting 86.5�11 vs. 89.4�15, p�0.33 andpostprandial 127.4�16 vs. 124�24, p�0.35) did not differ between glyburide andinsulin groups. Neonatal hypoglycemia was associated with macrosomia(p�0.001) and the incidence progressively increased with increasing birth weight(p�0.003). The rate of macrosomia did not vary between treatment groups (diet15% vs. pharmacotherapy 19%, p�0.47 or glyburide 16% vs. insulin 24%, p�.27).Macrosomia was significantly associated with maternal body mass index upon pre-sentation to prenatal care (p�0.005).

CONCLUSION: Women with type II and GDM treated with glyburide and insu-lin have a higher incidence of neonatal hypoglycemia than diet treated patients. Astrong determinant for the development of neonatal hypoglycemia was macroso-mia. Macrosomia itself was strongly associated with maternal obesity.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.370

354 PREGNANCY OUTCOMES IN TYPE 2 DIABETICS COMPARED WITH TYPE 1 DIABETICSAND NON-DIABETIC CONTROLS KRISTIN KNIGHT1, LORALEI THORNBURG1, EVAPRESSMAN1, 1University of Rochester, Obstetrics and Gynecology, Rochester, NewYork

OBJECTIVE: Pregestational diabetics have worse perinatal outcomes than non-diabetics, however the majority of studies have been limited to type 1 diabetics orhave not differentiated between type 1 and type 2 diabetes. Due to the increasingprevalence of type 2 diabetes, we sought to further characterize the maternal andfetal perinatal outcomes of type 2 diabetics compared with type 1 diabetics andcontrols.

STUDY DESIGN: Using an existing database of pregestational diabetics, we ret-rospectively reviewed maternal and fetal perinatal outcomes of singleton pregnan-cies between July 2000 and August 2006 in type 1 and type 2 diabetics compared tomatched controls (1:2) with normal glucose screening in pregnancy. We usedANOVA testing to compare diabetic groups and controls, T-testing to comparetype 1 and type 2 diabetics, and Chi-square analysis to compare categorical vari-ables.

RESULTS: 63 type 2 diabetics were compared with 64 type 1 diabetics and 254non-diabetic controls. 90.6% (58) of type 2 diabetics were on insulin during pregnancy.Mean HbA1c values did not differ significantly between type 1 and type 2 diabetics(7.1% vs. 6.9%, p�0.70). Both diabetic groups had higher incidences of Cesarean de-livery, preeclampsia, preterm delivery, polyhydramnios, LGA infant, and NICU admis-sion than controls (p�0.00001 for each), however the incidences were not different fortype 2 compared to type 1 diabetics. Type 1 diabetics had a higher incidence of com-posite poor neonatal outcome (perinatal death, RDS, sepsis, meconium aspiration,hypoglycemia, necrotizing enterocolitis, or intubation) than type 2 diabetics (p�0.023)and controls (p�0.00001). Type 1 diabetics had significantly more fetal congenitalanomalies than controls (6.3% vs. 1.2%; p�0.045), while type 2 diabetics althoughelevated were not significantly different (3.2%, p�0.050).

CONCLUSION: Type 2 diabetics have a similar incidence of adverse maternalpregnancy outcomes as type 1 diabetics, however they have an decreased incidenceof adverse neonatal outcomes.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.371

355 SCREENING FOR GESTATIONAL DIABETES: IS A 130MG/DL OR 140MG/DL GLUCOSECHALLENGE TEST THRESHOLD MORE COST-EFFECTIVE? STEPHEN THUNG1,CHRISTIAN PETTKER1, EDMUND FUNAI1, 1Yale University, New Haven, Connecticut

OBJECTIVE: To determine which 1-hour glucose challenge test (GCT) result—130 mg/dL vs. 140 mg/dL—is the more cost effective screening threshold for theascertainment of gestational diabetes (GDM).

STUDY DESIGN: We developed a decision analysis model comparing medicalcosts and perinatal outcomes when using a GCT threshold of either 130mg/dL or140mg/dL to identify pregnancies at risk for GDM. We also compared a 140mg/dLthreshold to a “no screening” strategy. Costs were from the perspective of the healthcare system. For both 130mg/dL and 140mg/dL strategies, GCT screening above theassigned threshold was followed by a diagnostic 3 hour glucose tolerance test(GTT). Pregnancies correctly identified with GDM received common interven-tions: diabetes educator counseling, home glycemic monitoring, insulin (whenindicated), and antenatal surveillance. Pregnancies with missed GDM received nointervention and had a higher incidence of adverse perinatal outcomes includingperinatal death and shoulder dystocia. The main outcome measure was marginalcost per QALY gained (cost/QALY) in the offspring. �$50,000/QALY gained wasconsidered cost effective.

RESULTS: Our model predicted that a lower GCT threshold of 130mg/dL couldimprove outcomes at a very modest cost. For every 100,000 pregnancies screenedusing 130mg/dL, the costs were increased an additional $808,961 and resulted in anadditional 54 QALYs gained, when compared to 140mg/dL. The cost/QALY was$14,961. The results were similar when 140mg/dL was compared to “no screening”with a cost/QALY of $12,269.

In the sensitivity analysis, the 130mg/dL threshold was no longer cost-effective(�$50,000/QALY gained) when: GDM prevalence was below 0.8% (base 3.3%),sensitivity of 130mg/dL threshold was � 82% (base 90%), specificity of 130mg/dLwas � 45% (base 78%), and the proportion of adverse perinatal outcomes due todeath was � 6% (base 20%).

CONCLUSION: The more sensitive threshold of 130mg/dL appears to be a cost-effective alternative to higher thresholds in most circumstances.

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.372

356 ONE ABNORMAL VALUE ON THE GTT: DOES IT MATTER WHICH? KARENPLAYFORTH1, LOIS BRUSTMAN1, CAROLYN SALAFIA1, SOPHIA SCARPELLI1, BARAKROSENN1, 1St. Luke’s Roosevelt Hospital Center, New York, New York

OBJECTIVE: Several studies have supported the validity of diagnosing gesta-tional diabetes (GDM) based on one abnormal value on the glucose tolerance test(GTT). The purpose of this study was to determine whether it matters which one ofthe four GTT values is abnormal.

STUDY DESIGN: From 01/05-06/07, 412 women with GDM were managed atour Diabetes in Pregnancy Center. Following a positive glucose challenge test(�130mg/dL), GDM was diagnosed based on one or more abnormal GTT valuesusing Carpenter and Coustan criteria. Women followed dietary instructions andself monitored blood glucose values 7 times a day. If good glycemic control (meanglucose �105mg/dL) was not achieved within 1-2 weeks, glyburide therapy wasbegun.Insulin was used when glyburide treatment failed or was contraindicated.Women were followed every 1-2 weeks and meter values were downloaded andanalyzed using meter-specific software. Chi square and ANOVA were used forstatistical analysis.

RESULTS: 88 of 412 women had 1 abnormal GTT value and are grouped in thetable based on which of the 4 values was abnormal. Mean glucose area under thecurve during GTT (AUC), mean glucose after initial diet therapy and during the last2 weeks of pregnancy, and percent glucose values within targets were similar in all4 groups.

CONCLUSION: When the diagnosis of GDM is based on one abnormal GTTvalue, it does not matter which of the 4 values is abnormal.

Abnormal value Fasting 1-hour 2-hour 3-hour

n 5 33 41 9GTT AUC 386 � 40 413 � 29 423 � 27 407 � 20Initial glucose 108 � 13 96 � 10 98 � 12 97 � 2Final glucose 99 � 10 95 � 10 96 � 10 93 � 5Good control 80% 91% 86% 100%values within targets 16 � 9% 14 � 11% 16 � 12% 11 � 5%Glyburide/insulin 100% 33% 29% 22%

0002-9378/$ - see front matterdoi:10.1016/j.ajog.2007.10.373

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