- Email: [email protected]
569: Does an immediate postpartum GTT and HgA1C in women with gestational diabetes identify those at greatest risk for development of type 2 diabetes mellitus?
Poster Session III
ajog.org
study by our group, first trimester prognostic models for GDM were externally validated. In this study, the area under the receiveroperator-curve (AUC) was calculated for the five best performing refitted models. The effect of adding a first trimester random glucose measurement to the AUC of these models was calculated as well. The predictive accuracy of these models was compared with that of a model solely based on the presence of one or more pre-specified risk factors. According to Dutch guidelines these risk factors are BMI >30 kg/m2, history of GDM, first degree family member with diabetes mellitus, non-western ethnicity, presence of polycystic ovary syndrome or a history of unexplained intra-uterine fetal death. These women were tested for GDM with an oral glucose tolerance test at gestational age 24-28 weeks. RESULTS: The AUCs of the refitted first trimester prognostic models for GDM varied from 0.77 (95%CI 0.74-0.80) to 0.79 (95%CI 0.760.82). The addition of the first trimester random glucose measurement improved all models, to a maximum AUC of 0.82 (95%CI 0.79-0.85) for the best performing model. In the current situation, standard care identifies 65% of all GDM cases by screening 28% of the population. Table 1 shows that this can be improved by the use of prognostic models for GDM. CONCLUSION: First trimester prognostic models for the development of GDM have a better predictive performance than prediction based on risk factors for GDM only, which offers opportunities for prevention and screening of GDM.
569 Does an immediate postpartum GTT and HgA1C in women with gestational diabetes identify those at greatest risk for development of type 2 diabetes mellitus? Cheryl Dinglas, Jolene Muscat, Hye Heo, Shahidul Islam, Anthony Vintzileos Winthrop University Hospital, Mineola, NY
568 First trimester prognostic models for the development of gestational diabetes: a clinical impact analysis Fieke van Hoorn1, Maria P. H. Koster1,2, Marije Lamain-de Ruiter1, Anneke Kwee1, Arie Franx1, Mireille N. Bekker1, on behalf of the RESPECT study group 1 Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, Netherlands, 2Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
OBJECTIVE: The aim of this study was to evaluate the clinical impact
of first trimester prognostic models for the development of gestational diabetes mellitus (GDM). STUDY DESIGN: The clinical impact of prognostic models for GDM was analysed in a Dutch population-based prospective cohort study containing 3,723 pregnancies recruited before 14 weeks of pregnancy. Women with pre-existing diabetes mellitus of any type were excluded. In total 181 women (4.9%) developed GDM. In a previous
OBJECTIVE: To determine if HgA1c and a 2 hour glucose tolerance test (GTT) performed in the immediate postpartum period can identify gestational diabetics at greatest risk for developing Type 2 Diabetes Mellitus (DM). STUDY DESIGN: An IRB-approved prospective cohort trial was performed at a single institution from 2/2013 to 1/2016. Women with gestational diabetes were enrolled for an immediate inpatient fasting 2-hour GTT and HgA1C performed within postpartum days 1 through 4. Exclusion criteria included multiple gestations, pregestational diabetes and a history of chronic steroid use. Standard 612 week postpartum glucose testing was also performed. Testing was considered abnormal if the fasting value was 100 mg/dL and/or if the 2 hour value was 140 mg/dL. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the immediate GTT to predict abnormal standard postpartum glucose testing were calculated. Pearson’s correlation was performed to assess the association between HgA1C and both immediate and standard postpartum GTT results.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S335
Poster Session III RESULTS: Seventy-five of 81 women enrolled in the study had an immediate postpartum GTT and HgA1C drawn. Mean age was 34 +/- 5 years, mean pre-pregnancy BMI was 29 +/-6 kg/m2 and mean HgA1C was 5.6% +/- 0.6%. Of patients that completed the immediate GTT, only 36 (48%) completed the standard postpartum glucose testing. All patients with a normal immediate GTT had normal postpartum glucose testing (NPV¼100%) (Table 1 ). All patients with abnormal postpartum glucose testing had an abnormal immediate GTT (Sensitivity¼100%). HgA1C values correlated with both the immediate and standard postpartum fasting values; however, there was no significant correlation between HgA1C and the immediate or standard postpartum 2 hour GTT values. CONCLUSION: While assessment of HgA1C immediately postpartum may be more convenient, an immediate GTT can better identify women at greatest risk for developing Type 2 Diabetes. With poor compliance for the standard postpartum 6-12 week GTT, immediate screening can be used to identify women who would most benefit from targeted early intervention and counseling.
ajog.org section increased with time (figure 1). Table 1 summarises the maternal characteristics and neonatal outcome. While there was no significant difference in respiratory morbidity requiring ventilatory support, there was an increased need for high level nursery care and intravenous therapy for hypoglycemia in neonates exposed to ACS. However, after adjusting for gestational age, these findings were not statistically significant. CONCLUSION: There was no beneficial effect of ACS on respiratory morbidity in neonates of women with pre-gestational diabetes who delivered by elective caesarean section after 36 weeks. We observed a trend towards greater neonatal complications, including need for high level nursery care and hypoglycaemia, in women who received ACS, however this was not apparent after adjusting for gestational age. Together with potential long term risks associated with ACS exposure, this study validates the need for a randomised controlled trial to assess the neonatal impacts of ACS prior to elective caesarean section at term in women with pre-gestational diabetes. Maternal characteristics and neonatal outcomes Characteristic
Steroids (n = 27)
No steroids (n = 133) p value
Maternal Age
31.37 +/- 7.01
33.26 +/- 5.33
HbA1C (%)
6.73 +/- 1.05
6.54 +/- 1.13
0.19 0.43
Nulliparous
9 (33.3%)
24 (18.0%)
Multiparous
18 (66.7%)
109 (82.0%)
Gestational age at delivery (weeks)
37.08 +/- 0.50
37.73 +/- 0.75
Birth weight (g)
3891.40 +/- 611.92 3621.75 +/- 667.84
Neonatal Outcome
Steroids (n = 27)
No steroids (n = 133) p value OR (adjusted for gestational age)
High level nursery care
16 (59.3%)
0.07 < 0.05 < 0.05
53 (39.8%)
0.06
1.99 (0.85 - 4.68)
Respiratory distress requiring ventilatory support 3 (11.1%)
13 (9.8%)
0.83
1.20 (0.32 - 4.56)
Hypoglycaemia requiring IV therapy
12 (44.4%)
39 (29.3%)
0.12
2.06 (0.88 - 4.87)
Potential sepsis requiring IV antibiotics
3 (11.1%)
17 (12.8%)
0.81
0.89 (0.24-3.29)
570 Antenatal corticosteroid administration for fetal lung maturation prior to elective caesarean section at term in women with pre-gestational diabetes - more harm than good? Iniyaval Thevathasan1, Sofia C. Walker2, Laura Leung1, Julia Unterscheider1,3, Joanne Said2,3 1
The Royal Women’s Hospital, Parkville, Australia, 2Sunshine Hospital, St Albans, Australia, 3University of Melbourne, Parkville, Australia
OBJECTIVE: Evidence is accumulating to suggest benefit when ante-
natal corticosteroids (ACS) are administered prior to elective caesarean section at term; however the value of this intervention is not well established in women with pre-gestational diabetes. We aimed to describe the effect of ACS on neonatal outcomes in women with pre-gestational diabetes, when administered within 10 days of elective caesarean delivery. STUDY DESIGN: We conducted a retrospective cohort study of pregnant women with pre-gestational diabetes in two academic obstetric centers in Australia. Patients who delivered by elective caesarean section between 36 0/7 and 38 6/7 weeks gestation between 2010 and 2015 were identified using the hospitals’ electronic medical records. Differences in maternal demographics were analysed using Student’s t-test or Chi-squared test. The relationship between the use of ACS and neonatal outcomes was investigated using the Chi-squared test. Multivariable logistical regression was undertaken to account for confounders such as gestation. RESULTS: During the study period, a total of 160 women were identified of whom 27 (17%) were exposed to ACS and 133 (83%) were not. The prevalence of ACS use prior to elective caesarean
571 Antenatal corticosteroid administration prior to elective caesarean section in women with gestational diabetes requiring insulin - more harm than benefit? Iniyaval Thevathasan1, Sofia Walker2, Laura Leung1, Julia Unterscheider1,3, Joanne Said2,3 1
The Royal Women’s Hospital, Parkville, Australia, 2Sunshine Hospital, St Albans, Australia, 3University of Melbourne, Parkville, Australia
OBJECTIVE: Emerging evidence suggests a benefit of late antenatal corticosteroids (ACS) administration in women undergoing elective caesarean section up to 38 6/7 gestation; whether this recommendation can be extended to women with gestational diabetes (GDM) is the subject of debate. We aimed to describe the effect of ACS on neonatal outcomes in women with GDM requiring insulin, when administered within 10 days of elective caesarean delivery.
S336 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
ajog.org
study by our group, first trimester prognostic models for GDM were externally validated. In this study, the area under the receiveroperator-curve (AUC) was calculated for the five best performing refitted models. The effect of adding a first trimester random glucose measurement to the AUC of these models was calculated as well. The predictive accuracy of these models was compared with that of a model solely based on the presence of one or more pre-specified risk factors. According to Dutch guidelines these risk factors are BMI >30 kg/m2, history of GDM, first degree family member with diabetes mellitus, non-western ethnicity, presence of polycystic ovary syndrome or a history of unexplained intra-uterine fetal death. These women were tested for GDM with an oral glucose tolerance test at gestational age 24-28 weeks. RESULTS: The AUCs of the refitted first trimester prognostic models for GDM varied from 0.77 (95%CI 0.74-0.80) to 0.79 (95%CI 0.760.82). The addition of the first trimester random glucose measurement improved all models, to a maximum AUC of 0.82 (95%CI 0.79-0.85) for the best performing model. In the current situation, standard care identifies 65% of all GDM cases by screening 28% of the population. Table 1 shows that this can be improved by the use of prognostic models for GDM. CONCLUSION: First trimester prognostic models for the development of GDM have a better predictive performance than prediction based on risk factors for GDM only, which offers opportunities for prevention and screening of GDM.
569 Does an immediate postpartum GTT and HgA1C in women with gestational diabetes identify those at greatest risk for development of type 2 diabetes mellitus? Cheryl Dinglas, Jolene Muscat, Hye Heo, Shahidul Islam, Anthony Vintzileos Winthrop University Hospital, Mineola, NY
568 First trimester prognostic models for the development of gestational diabetes: a clinical impact analysis Fieke van Hoorn1, Maria P. H. Koster1,2, Marije Lamain-de Ruiter1, Anneke Kwee1, Arie Franx1, Mireille N. Bekker1, on behalf of the RESPECT study group 1 Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, Netherlands, 2Department of Obstetrics & Gynaecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
OBJECTIVE: The aim of this study was to evaluate the clinical impact
of first trimester prognostic models for the development of gestational diabetes mellitus (GDM). STUDY DESIGN: The clinical impact of prognostic models for GDM was analysed in a Dutch population-based prospective cohort study containing 3,723 pregnancies recruited before 14 weeks of pregnancy. Women with pre-existing diabetes mellitus of any type were excluded. In total 181 women (4.9%) developed GDM. In a previous
OBJECTIVE: To determine if HgA1c and a 2 hour glucose tolerance test (GTT) performed in the immediate postpartum period can identify gestational diabetics at greatest risk for developing Type 2 Diabetes Mellitus (DM). STUDY DESIGN: An IRB-approved prospective cohort trial was performed at a single institution from 2/2013 to 1/2016. Women with gestational diabetes were enrolled for an immediate inpatient fasting 2-hour GTT and HgA1C performed within postpartum days 1 through 4. Exclusion criteria included multiple gestations, pregestational diabetes and a history of chronic steroid use. Standard 612 week postpartum glucose testing was also performed. Testing was considered abnormal if the fasting value was 100 mg/dL and/or if the 2 hour value was 140 mg/dL. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the immediate GTT to predict abnormal standard postpartum glucose testing were calculated. Pearson’s correlation was performed to assess the association between HgA1C and both immediate and standard postpartum GTT results.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S335
Poster Session III RESULTS: Seventy-five of 81 women enrolled in the study had an immediate postpartum GTT and HgA1C drawn. Mean age was 34 +/- 5 years, mean pre-pregnancy BMI was 29 +/-6 kg/m2 and mean HgA1C was 5.6% +/- 0.6%. Of patients that completed the immediate GTT, only 36 (48%) completed the standard postpartum glucose testing. All patients with a normal immediate GTT had normal postpartum glucose testing (NPV¼100%) (Table 1 ). All patients with abnormal postpartum glucose testing had an abnormal immediate GTT (Sensitivity¼100%). HgA1C values correlated with both the immediate and standard postpartum fasting values; however, there was no significant correlation between HgA1C and the immediate or standard postpartum 2 hour GTT values. CONCLUSION: While assessment of HgA1C immediately postpartum may be more convenient, an immediate GTT can better identify women at greatest risk for developing Type 2 Diabetes. With poor compliance for the standard postpartum 6-12 week GTT, immediate screening can be used to identify women who would most benefit from targeted early intervention and counseling.
ajog.org section increased with time (figure 1). Table 1 summarises the maternal characteristics and neonatal outcome. While there was no significant difference in respiratory morbidity requiring ventilatory support, there was an increased need for high level nursery care and intravenous therapy for hypoglycemia in neonates exposed to ACS. However, after adjusting for gestational age, these findings were not statistically significant. CONCLUSION: There was no beneficial effect of ACS on respiratory morbidity in neonates of women with pre-gestational diabetes who delivered by elective caesarean section after 36 weeks. We observed a trend towards greater neonatal complications, including need for high level nursery care and hypoglycaemia, in women who received ACS, however this was not apparent after adjusting for gestational age. Together with potential long term risks associated with ACS exposure, this study validates the need for a randomised controlled trial to assess the neonatal impacts of ACS prior to elective caesarean section at term in women with pre-gestational diabetes. Maternal characteristics and neonatal outcomes Characteristic
Steroids (n = 27)
No steroids (n = 133) p value
Maternal Age
31.37 +/- 7.01
33.26 +/- 5.33
HbA1C (%)
6.73 +/- 1.05
6.54 +/- 1.13
0.19 0.43
Nulliparous
9 (33.3%)
24 (18.0%)
Multiparous
18 (66.7%)
109 (82.0%)
Gestational age at delivery (weeks)
37.08 +/- 0.50
37.73 +/- 0.75
Birth weight (g)
3891.40 +/- 611.92 3621.75 +/- 667.84
Neonatal Outcome
Steroids (n = 27)
No steroids (n = 133) p value OR (adjusted for gestational age)
High level nursery care
16 (59.3%)
0.07 < 0.05 < 0.05
53 (39.8%)
0.06
1.99 (0.85 - 4.68)
Respiratory distress requiring ventilatory support 3 (11.1%)
13 (9.8%)
0.83
1.20 (0.32 - 4.56)
Hypoglycaemia requiring IV therapy
12 (44.4%)
39 (29.3%)
0.12
2.06 (0.88 - 4.87)
Potential sepsis requiring IV antibiotics
3 (11.1%)
17 (12.8%)
0.81
0.89 (0.24-3.29)
570 Antenatal corticosteroid administration for fetal lung maturation prior to elective caesarean section at term in women with pre-gestational diabetes - more harm than good? Iniyaval Thevathasan1, Sofia C. Walker2, Laura Leung1, Julia Unterscheider1,3, Joanne Said2,3 1
The Royal Women’s Hospital, Parkville, Australia, 2Sunshine Hospital, St Albans, Australia, 3University of Melbourne, Parkville, Australia
OBJECTIVE: Evidence is accumulating to suggest benefit when ante-
natal corticosteroids (ACS) are administered prior to elective caesarean section at term; however the value of this intervention is not well established in women with pre-gestational diabetes. We aimed to describe the effect of ACS on neonatal outcomes in women with pre-gestational diabetes, when administered within 10 days of elective caesarean delivery. STUDY DESIGN: We conducted a retrospective cohort study of pregnant women with pre-gestational diabetes in two academic obstetric centers in Australia. Patients who delivered by elective caesarean section between 36 0/7 and 38 6/7 weeks gestation between 2010 and 2015 were identified using the hospitals’ electronic medical records. Differences in maternal demographics were analysed using Student’s t-test or Chi-squared test. The relationship between the use of ACS and neonatal outcomes was investigated using the Chi-squared test. Multivariable logistical regression was undertaken to account for confounders such as gestation. RESULTS: During the study period, a total of 160 women were identified of whom 27 (17%) were exposed to ACS and 133 (83%) were not. The prevalence of ACS use prior to elective caesarean
571 Antenatal corticosteroid administration prior to elective caesarean section in women with gestational diabetes requiring insulin - more harm than benefit? Iniyaval Thevathasan1, Sofia Walker2, Laura Leung1, Julia Unterscheider1,3, Joanne Said2,3 1
The Royal Women’s Hospital, Parkville, Australia, 2Sunshine Hospital, St Albans, Australia, 3University of Melbourne, Parkville, Australia
OBJECTIVE: Emerging evidence suggests a benefit of late antenatal corticosteroids (ACS) administration in women undergoing elective caesarean section up to 38 6/7 gestation; whether this recommendation can be extended to women with gestational diabetes (GDM) is the subject of debate. We aimed to describe the effect of ACS on neonatal outcomes in women with GDM requiring insulin, when administered within 10 days of elective caesarean delivery.
S336 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017