a

CF

tg

b1iogcte

Bg19c9Bwncb

tSt

p

oF

w

Poster Session IV www.AJOG.orgFriday, February 11, 2011 • 3:30 pm – 5:30 pm • Grand Ballroom, Hilton San Francisco

EPIDEMIOLOGY, GLOBAL MATERNAL-FETAL PUBLIC HEALTH, INFECTIOUSDISEASE, INTRAPARTUM FETAL ASSESSMENT, OPERATIVE OBSTETRICS

Abstracts 537 – 686

l(ocneu

tOct

fc

aown

6filni

537 Maternal BMI, glucose tolerance,nd adverse pregnancy outcomes

Alison Stuebe1

1For the Eunice Kennedy Shriver National Institute ofhild Health and Human Development Maternal-etal Medicine Units Network, Bethesda, MD

OBJECTIVE: To measure the independent effects of BMI and glucoseolerance on pregnancy outcome among women with mild gestationallucose intolerance.

STUDY DESIGN: We used logistic regression to model the associationsetween pregravid BMI, 3-hour OGTT results (fasting �95mg/dl,-h, 2-h, and 3-h), and pregnancy outcomes among women enrolledn a multicenter study of treatment of mild GDM and its associatedbservational cohort. We included in our analysis women with a 50-ram screen between 135 and 199 mg/dL who either did not meetriteria for GDM or met criteria for GDM but were randomized to noreatment. All models were adjusted for parity, maternal age and race/thnicity.

RESULTS: Among 1198 women eligible for analysis, both maternalMI and glucose at hour 3 of the OGTT were directly associated withestational hypertension/preeclampsia (OR per 5 BMI unit increase:.29, 95%CI 1.10-1.51; OR per 10 mg/dL 3h glucose increase: 1.09,5%CI 1.01-1.17). Increasing maternal BMI was also positively asso-iated with LGA birth weight (BWT: OR per 5 BMI unit increase 1.21,5%CI 1.03-1.41) and negatively associated with SGA BWT (OR per 5MI unit increase .77, 95%CI .61-.97). Neither BMI nor OGTT valuesere associated with preeclampsia. We did not find a statistically sig-ificant association between maternal BMI, fasting OGTT and theomposite outcome (perinatal mortality, hypoglycemia, hyperbiliru-inemia, neonatal hyperinsulinemia, or birth trauma).

CONCLUSIONS: In a population of untreated women with mild gesta-ional glucose intolerance, BMI is more strongly associated with LGA,GA and gestational hypertension/preeclampsia than parameters ofhe 3-hour OGTT.

Table: Association between pregravid BMI (OR per 5 unit increase, 95% CI), OGTTparameters (OR per 10mg/dL increase, 95% CI), and pregnancy outcomes

Pregravid BMI Fasting OGTT 1-hour OGTT 2-hour OGTT 3-hour OGTT

Mean (SD) 26.6 (5.6) 85 (6) 167 (30) 144 (30) 117 (28)..........................................................................................................................................................................................gHTN/preeclampsia 1.29 (1.10-1.51) 1.04 (.74-1.45) 1.06 (.97-1.15) 1.01 (.92-1.11) 1.09 (1.01-1.17)..........................................................................................................................................................................................LGA 1.21 (1.03-1.41) 1.21 (.88-1.67) 1.01 (.93-1.10) 1.09 (1.00-1.19) 1.00 (.93-1.07)..........................................................................................................................................................................................SGA .77 (.61-.97) .85 (.58-1.24) .97 (.89-1.07) .99 (.89-1.10) .98 (.90-1.07)..........................................................................................................................................................................................Preeclampsia 1.13 (.89-1.43) 1.03 (.63-1.67) 1.04 (.91-1.18) 1.04 (.91-1.19) 1.02 (.91-1.13)..........................................................................................................................................................................................Composite outcome 1.11 (.99-1.25) 1.20 (.97-1.50) 1.03 (.97-1.09) 1.01 (.96-1.08) 1.02 (.97-1.07)..........................................................................................................................................................................................

Bold indicates p �0.05.

538 Is there a threshold OGTT value forredicting adverse neonatal outcome?

Alison Stuebe1

1For the Eunice Kennedy Shriver National Institutef Child Health and Human Development Maternal-etal Medicine Units Network, Bethesda, MD

OBJECTIVE: To determine whether there is an OGTT threshold abovehich glucose intolerance predicts adverse newborn outcomes.

STUDY DESIGN: Among women enrolled in a multicenter study oftreatment of mild GDM and its associated observational cohort, we

used the generalized additive models to explore non-linear associa- t

S216 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

tions between each of the 3-hour OGTT values (fasting, 1-h, 2-h, and3-h) and the study’s composite outcome (perinatal mortality, hypo-glycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/orbirth trauma). Generalized additive models used non-parametric re-gression to identify non-linear associations among predictors andoutcomes. We further modeled the association between OGTT andcomposite outcome using all four OGTT values in a single model. Tobe eligible for inclusion in the study, participants were required tohave a 50g glucose loading test value between 135 and 199 mg/dL anda fasting OGTT value �95 mg/dL. We included in our analysis womenwho either did not meet criteria for GDM or met criteria for mildGDM but were randomized to no treatment.RESULTS: Among 1303 eligible women, each timed OGTT value wasinearly associated with increased odds of the composite outcomeTable). When all four OGTT values were included in a single model,nly fasting OGTT was linearly associated with the composite out-ome (OR per 10 mg/dL increase 1.33, 95% CI 1.09-1.63). We foundo evidence of departure from linearity for any of the OGTT values,ither in single-value models or the model incorporating all four val-es (all Analysis of Deviance Chi-Square p values � 0.4).

CONCLUSIONS: In a population of untreated women with mild gesta-ional glucose intolerance and fasting OGTT � 95 mg/dL, fastingGTT values were directly associated with risk of the composite out-

ome. We found no evidence of threshold OGTT values above whichhere is a non-linear increase in neonatal complications.

Table: Increasing glucose intolerance and composite neonatal outcome (OR per 10 mg/dL)

Fasting OGTT 1h OGTT 2h OGTT 3h OGTT

Mean (SD), mg/dL 85 (6) 167 (30) 144 (30) 117 (28)..........................................................................................................................................................................................Single OGTT value 1.33 (1.09-1.63) 1.07 (1.03-1.11) 1.06 (1.02-1.10) 1.05 (1.01-1.09)..........................................................................................................................................................................................Mutually adjustedfor all 4 OGTTvalues

1.23 (1.00-1.52) 1.04 (.99-1.10) 1.02 (.96-1.08) 1.02 (.98-1.07)

..........................................................................................................................................................................................

539 Short interpregnancy intervals are a risk factoror postneonatal infant mortality: risks are notonfined to the perinatal and neonatal periods

Allison Bryant1, Erin Madden2

1Massachusetts General Hospital, Boston, MA, 2NCIRE, San Francisco, CAOBJECTIVE: It is known that short birth-to-conception intervals aressociated with an increased risk of adverse pregnancy outcomes andf infant death in the first 30 days of life. We sought to determinehether this risk of mortality extends to infant mortality beyond theeonatal period.

STUDY DESIGN: We used data from vital statistics (birth, infant andfetal death) records for all births in California between 1999 and 2004,linked with hospital discharge data. For women with a first birth in1999-2000 and a second birth by the end of 2004, multivariable mod-eling was used to determine the association between short interpreg-nancy intervals (IPIs) and postneonatal death.RESULTS: Of infants born to 191,081 women meeting study criteria,

80 (0.36%) died in the first year of life: 420 (0.22%) died during therst 30 days of life and 260 (0.14%) died between 31 and 365 days of

ife. Significant sociodemographic and clinical risk factors for post-eonatal infant death are presented in the Table. An IPI of �6m was

ndependently and strongly associated with the risk of all infant mor-

ality, including the risk of postneonatal mortality.

011