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247: Does the degree of proteinuria in early pregnancy correlate with risk of preeclampsia in pregestational diabetes?
Poster Session II
Diabetes, Labor, Ultrasound-Imaging
mIL-10 (r⫽0.88, p ⬍ 0.0001), and f HOMA-IR was correlated with f IL-10 (r⫽0.53, p⫽0.03), but no such correlation was noted in GDM subjects. CONCLUSIONS: In pregnancy, f HOMA-IR mirrors mHOMA-IR, and f HOMA-IR is correlated with f leptin. The pro-inflammatory cytokine mTNF-alpha is higher in GDM than non-GDM mothers. In nonGDM pregnancy, physiological insulin resistance is associated with higher IL-10 in both fetus and mother. In GDM this compensatory response is lost, perhaps predisposing women with GDM to develop type II DM later in life.
246 Fasting plasma active glucagon-like peptide-1 (GLP-1) in pregnancies with and without gestational diabetes (GDM) Cecilia Avila1, Elizabeth Garduno2, John Chen2, Andrew Lane2, Hyeong Jun Ahn2, Jarrett Santorelli2, Alexander Kong2, Jacob Mathai2, Jolene Muscat3, Paul L. Ogburn1, Juana Gonzalez4 1 Stony Brook-Winthrop University Hospitals, Long Island, NY, 2Stony Brook University Medical Center, Stony Brook, NY, 3Stony Brook-Winthrop University Hospitals, Stony Brook, NY, 4Rockefeller University, New York, NY
OBJECTIVE: GLP-1, an incretin hormone is secreted from intestinal endocrine L-cells inresponse to feeding, stimulates glucose-dependent insulin secretion, reduces food intake and regulates pancreatic beta cell mass. It is decreased in type 2 DM. Levels increase throughout gestation. Our goals were to compare GLP-1 levels in maternal plasma, umbilical artery and vein in GDM and non-GDM cases and assess their correlation with insulin resistance (HOMA-IR). STUDY DESIGN: 15 GDM and 22 non-GDM women scheduled for a term cesarean delivery were recruited. Maternal blood samples were obtained prior to surgery. After delivery, both venous and arterial cord blood were obtained. Electrochemiluminescent assay was used for active GLP-1 and insulin plasma quantification. HOMA-IR was calculated. Linear association was summarized by correlation coefficient and t-tests were used to compare GDM and non-GDM groups. RESULTS: There was no statistically significant difference in maternal GLP-1, fetal arterial or venous GLP-1 between GDM and non-GDM cases. There was a significant positive correlation between maternal pre delivery BMI and fetal arterial (r⫽0.36, p⫽0.029) and venous GLP-1 (r⫽0.46, p⫽0.004). There was also a significant positive correlation between maternal BMI at delivery and fetal arterial (r⫽0.38, p⫽0.022), and venous GLP-1 (r⫽0.51, p⫽0.002). There were no significant differences between fetal arterial and venous GLP-1 in GDM (p⫽0.44) or non-GDM cases (p⫽0.41). Birth weight (BW) was positively correlated with fetal arterial (r⫽0.45, p⫽0.005) and venous GLP-1 (r⫽0.34, p⫽0.039). There was a significant positive correlation between maternal GLP-1 and HOMA-IR in GDM cases (r⫽0.69, p⫽0.005) but not in non-GDM cases (p⫽0.68). CONCLUSIONS: GLP-1 levels in GDM and non-GDM cases did not differ. This may be due to wide variation in glycemic control in GDM cases, or due to elevated BMI in both groups as higher GLP-1 was associated with elevated BMI. Higher GLP-1 levels are associated with higher HOMA-IR in GDM cases. Arterial and venous umbilical GLP-1 did not differ, and future studies may be conducted on mixed cord blood.
247 Does the degree of proteinuria in early pregnancy correlate with risk of preeclampsia in pregestational diabetes? Celeste Durnwald1, Courtney Lynch1, Mark Landon1
www.AJOG.org
urine (24 HP) was measured via pyrogallol red method. Women were divided into 3 categories as follows: Normal ⬍ 150 mg/dL, Elevated 150-300 mg/dL and Nephropathy ⬎ 300mg/dL. The association between level of proteinuria and development of preeclampsia was analyzed. RESULTS: Of those studied (n⫽90), 52 had Normal 24HP, 24 had Elevated 24HP, and 14 had Nephropathy. Preeclampsia was diagnosed in 21 (23.3%) of pregnancies. Mean gestational age at diagnosis was 35.2 weeks (range 28.4-38.4 wks). There was no difference in rates of preeclampsia in those women with Elevated 24 HP (17.9%) compared with Normal (16.6%), p⫽0.89. In contrast, women with Nephropathy had significantly higher rates of preeclampsia (47.4%) compared with Normal (47.4 vs. 16.6%, p⫽0.005). Baseline hemoglobin A1c of women developing preeclampsia was similar to those who remained normotensive (7.9% vs. 8.1%, p⫽0.64). After controlling for race, maternal age, prior history of preeclampsia, chronic hypertension and hemoglobin A1c, only Nephropathy levels of early proteinuria were associated with an increased risk of developing preeclampsia. CONCLUSIONS: Mild proteinuria above 150 mg/24 hours in early pregnancy is not associated with an increased risk of preeclampsia in women with pregestational diabetes, whereas nephropathic levels do increase the risk.
248 The contribution of glycemic control on the development of preeclampsia in the diabetic gravida Celeste Durnwald1, Courtney Lynch1, Mark Landon1 1
The Ohio State University, Columbus, OH
OBJECTIVE: To examine the association between glycemic control and
the development of preeclampsia in women with preexisting diabetes in pregnancy. STUDY DESIGN: Retrospective study of women with preexisting (Type 1 and 2) diabetes enrolled in a diabetes in pregnancy program from 2004-2008. Baseline hemoglobin A1c was recorded. Women performed daily fasting and 2 hour postprandial fingerstick self blood glucose monitoring and values were recorded. Median fasting and 2 hour postprandial blood glucose values were analyzed for the 4-6 week period prior to the development of preeclampsia or delivery. Preeclampsia was defined as two blood pressure measurements ⬎140/90 six hours apart and proteinuria (either 24 hour urine ⱖ 300mg/dL or 2⫹ on urinary dipstick). Severity of preeclampsia (mild vs. severe) was also recorded. The association between glycemia and the development of preeclampsia was analyzed using multivariable logistic regression. RESULTS: Of 154 diabetic women, 23.4% developed preeclampsia. 24% were Black, 12.3% were chronic hypertensive, 10.4 % had vascular complications and 5.2% had a prior history of preeclampsia. Maternal age (28.4 vs. 29.7 yrs, p⫽0.25) and baseline hemoglobin A1c (8.0% vs. 7.2%, p⫽0.09) were similar between preeclamptic and nonpreeclamptic women. Median fasting (97.4 ⫾ 18.8 mg/dL vs. 100.1 ⫾ 18.9 mg/dL, p⫽0.45) and 2 hour postprandial glucose (115.4 ⫾ 19.1mg/dL vs. 117.3 ⫾ 15.6 mg/dL, p⫽0.55) did not differ in those with preeclampsia compared with their normal counterparts. Target values of ⬍ 95 fasting and ⬍ 120 postprandial were achieved at similar rates between groups, p⫽0.8 and 0.4, respectively. After controlling for race, baseline A1c, prior preeclampsia and vascular complications of preeclampsia, glycemia was not independently associated with the development of preeclampsia. CONCLUSIONS: In a well controlled diabetic population, glycemia is not associated with the development of preeclampsia.
1
The Ohio State University, Columbus, OH
OBJECTIVE: To determine if mild proteinuria (150-300 mg/24 hour
collection) ⬍ 20 weeks gestation increases the risk of developing preeclampsia in women with pregestational diabetes. STUDY DESIGN: Retrospective study of women with preexisting (Type 1 and 2) diabetes enrolled in a diabetes in pregnancy program from 2004-2008. On enrollment, women completed a 24 hour urine collection to evaluate baseline renal function. Protein excretion in 24 hour
S106
249 Predictive characteristics of elevated 1-hour glucose loading test results for gestational diabetes Dana Figueroa1 1
University of Alabama at Birmingham, Birmingham, AL
OBJECTIVE: To evaluate the predictive characteristics of the 1-hour
50gm glucose loading test (GLT) for the diagnosis of gestational diabetes (GDM) among women with elevated GLT results of 135-199
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
Diabetes, Labor, Ultrasound-Imaging
mIL-10 (r⫽0.88, p ⬍ 0.0001), and f HOMA-IR was correlated with f IL-10 (r⫽0.53, p⫽0.03), but no such correlation was noted in GDM subjects. CONCLUSIONS: In pregnancy, f HOMA-IR mirrors mHOMA-IR, and f HOMA-IR is correlated with f leptin. The pro-inflammatory cytokine mTNF-alpha is higher in GDM than non-GDM mothers. In nonGDM pregnancy, physiological insulin resistance is associated with higher IL-10 in both fetus and mother. In GDM this compensatory response is lost, perhaps predisposing women with GDM to develop type II DM later in life.
246 Fasting plasma active glucagon-like peptide-1 (GLP-1) in pregnancies with and without gestational diabetes (GDM) Cecilia Avila1, Elizabeth Garduno2, John Chen2, Andrew Lane2, Hyeong Jun Ahn2, Jarrett Santorelli2, Alexander Kong2, Jacob Mathai2, Jolene Muscat3, Paul L. Ogburn1, Juana Gonzalez4 1 Stony Brook-Winthrop University Hospitals, Long Island, NY, 2Stony Brook University Medical Center, Stony Brook, NY, 3Stony Brook-Winthrop University Hospitals, Stony Brook, NY, 4Rockefeller University, New York, NY
OBJECTIVE: GLP-1, an incretin hormone is secreted from intestinal endocrine L-cells inresponse to feeding, stimulates glucose-dependent insulin secretion, reduces food intake and regulates pancreatic beta cell mass. It is decreased in type 2 DM. Levels increase throughout gestation. Our goals were to compare GLP-1 levels in maternal plasma, umbilical artery and vein in GDM and non-GDM cases and assess their correlation with insulin resistance (HOMA-IR). STUDY DESIGN: 15 GDM and 22 non-GDM women scheduled for a term cesarean delivery were recruited. Maternal blood samples were obtained prior to surgery. After delivery, both venous and arterial cord blood were obtained. Electrochemiluminescent assay was used for active GLP-1 and insulin plasma quantification. HOMA-IR was calculated. Linear association was summarized by correlation coefficient and t-tests were used to compare GDM and non-GDM groups. RESULTS: There was no statistically significant difference in maternal GLP-1, fetal arterial or venous GLP-1 between GDM and non-GDM cases. There was a significant positive correlation between maternal pre delivery BMI and fetal arterial (r⫽0.36, p⫽0.029) and venous GLP-1 (r⫽0.46, p⫽0.004). There was also a significant positive correlation between maternal BMI at delivery and fetal arterial (r⫽0.38, p⫽0.022), and venous GLP-1 (r⫽0.51, p⫽0.002). There were no significant differences between fetal arterial and venous GLP-1 in GDM (p⫽0.44) or non-GDM cases (p⫽0.41). Birth weight (BW) was positively correlated with fetal arterial (r⫽0.45, p⫽0.005) and venous GLP-1 (r⫽0.34, p⫽0.039). There was a significant positive correlation between maternal GLP-1 and HOMA-IR in GDM cases (r⫽0.69, p⫽0.005) but not in non-GDM cases (p⫽0.68). CONCLUSIONS: GLP-1 levels in GDM and non-GDM cases did not differ. This may be due to wide variation in glycemic control in GDM cases, or due to elevated BMI in both groups as higher GLP-1 was associated with elevated BMI. Higher GLP-1 levels are associated with higher HOMA-IR in GDM cases. Arterial and venous umbilical GLP-1 did not differ, and future studies may be conducted on mixed cord blood.
247 Does the degree of proteinuria in early pregnancy correlate with risk of preeclampsia in pregestational diabetes? Celeste Durnwald1, Courtney Lynch1, Mark Landon1
www.AJOG.org
urine (24 HP) was measured via pyrogallol red method. Women were divided into 3 categories as follows: Normal ⬍ 150 mg/dL, Elevated 150-300 mg/dL and Nephropathy ⬎ 300mg/dL. The association between level of proteinuria and development of preeclampsia was analyzed. RESULTS: Of those studied (n⫽90), 52 had Normal 24HP, 24 had Elevated 24HP, and 14 had Nephropathy. Preeclampsia was diagnosed in 21 (23.3%) of pregnancies. Mean gestational age at diagnosis was 35.2 weeks (range 28.4-38.4 wks). There was no difference in rates of preeclampsia in those women with Elevated 24 HP (17.9%) compared with Normal (16.6%), p⫽0.89. In contrast, women with Nephropathy had significantly higher rates of preeclampsia (47.4%) compared with Normal (47.4 vs. 16.6%, p⫽0.005). Baseline hemoglobin A1c of women developing preeclampsia was similar to those who remained normotensive (7.9% vs. 8.1%, p⫽0.64). After controlling for race, maternal age, prior history of preeclampsia, chronic hypertension and hemoglobin A1c, only Nephropathy levels of early proteinuria were associated with an increased risk of developing preeclampsia. CONCLUSIONS: Mild proteinuria above 150 mg/24 hours in early pregnancy is not associated with an increased risk of preeclampsia in women with pregestational diabetes, whereas nephropathic levels do increase the risk.
248 The contribution of glycemic control on the development of preeclampsia in the diabetic gravida Celeste Durnwald1, Courtney Lynch1, Mark Landon1 1
The Ohio State University, Columbus, OH
OBJECTIVE: To examine the association between glycemic control and
the development of preeclampsia in women with preexisting diabetes in pregnancy. STUDY DESIGN: Retrospective study of women with preexisting (Type 1 and 2) diabetes enrolled in a diabetes in pregnancy program from 2004-2008. Baseline hemoglobin A1c was recorded. Women performed daily fasting and 2 hour postprandial fingerstick self blood glucose monitoring and values were recorded. Median fasting and 2 hour postprandial blood glucose values were analyzed for the 4-6 week period prior to the development of preeclampsia or delivery. Preeclampsia was defined as two blood pressure measurements ⬎140/90 six hours apart and proteinuria (either 24 hour urine ⱖ 300mg/dL or 2⫹ on urinary dipstick). Severity of preeclampsia (mild vs. severe) was also recorded. The association between glycemia and the development of preeclampsia was analyzed using multivariable logistic regression. RESULTS: Of 154 diabetic women, 23.4% developed preeclampsia. 24% were Black, 12.3% were chronic hypertensive, 10.4 % had vascular complications and 5.2% had a prior history of preeclampsia. Maternal age (28.4 vs. 29.7 yrs, p⫽0.25) and baseline hemoglobin A1c (8.0% vs. 7.2%, p⫽0.09) were similar between preeclamptic and nonpreeclamptic women. Median fasting (97.4 ⫾ 18.8 mg/dL vs. 100.1 ⫾ 18.9 mg/dL, p⫽0.45) and 2 hour postprandial glucose (115.4 ⫾ 19.1mg/dL vs. 117.3 ⫾ 15.6 mg/dL, p⫽0.55) did not differ in those with preeclampsia compared with their normal counterparts. Target values of ⬍ 95 fasting and ⬍ 120 postprandial were achieved at similar rates between groups, p⫽0.8 and 0.4, respectively. After controlling for race, baseline A1c, prior preeclampsia and vascular complications of preeclampsia, glycemia was not independently associated with the development of preeclampsia. CONCLUSIONS: In a well controlled diabetic population, glycemia is not associated with the development of preeclampsia.
1
The Ohio State University, Columbus, OH
OBJECTIVE: To determine if mild proteinuria (150-300 mg/24 hour
collection) ⬍ 20 weeks gestation increases the risk of developing preeclampsia in women with pregestational diabetes. STUDY DESIGN: Retrospective study of women with preexisting (Type 1 and 2) diabetes enrolled in a diabetes in pregnancy program from 2004-2008. On enrollment, women completed a 24 hour urine collection to evaluate baseline renal function. Protein excretion in 24 hour
S106
249 Predictive characteristics of elevated 1-hour glucose loading test results for gestational diabetes Dana Figueroa1 1
University of Alabama at Birmingham, Birmingham, AL
OBJECTIVE: To evaluate the predictive characteristics of the 1-hour
50gm glucose loading test (GLT) for the diagnosis of gestational diabetes (GDM) among women with elevated GLT results of 135-199
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011