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583: Gestational weight gain in the obese and morbidly obese: how much is too much?
ajog.org
Poster Session IV
control for potential confounders. Outcomes included oligohydramnios, small for gestational age (SGA) <10%, intrauterine fetal demise (IUFD), preterm delivery (PTD), preeclampsia and cesarean delivery. RESULTS: Compared to other groups, Black women with pregestational diabetes had a higher incidence of preeclampsia, SGA <10%, IUFD and PTD. Black and Hispanic women had a higher incidence of oligohydramnios. Asian women with pregestational diabetes had a higher incidence of SGA <10% and lower incidence of preeclampsia and cesarean delivery (Table). This was confirmed in multivariate analyses. The odds ratios for Black women were 1.6 (95%CI 1.1-2.3) for oligohydramnios, 2.3 (95%CI 1.7-3.1) for SGA, 3.7 (95% CI 1.78.1) for IUFD, 1.4 (95% CI 1.1-1.6) for PTD, 1.3 (95% CI 1.0-1.7). The odds ratio for Hispanic women was 1.6 (95% CI 1.2-2.0) for oligohydramnios. The odds ratio for Asian women was 2.2 (95% CI 1.6-2.8) for SGA, 0.7 (95%CI 0.6-0.9) for preeclampsia and 0.6 (95% CI 0.5-0.8) for cesarean. CONCLUSION: Perinatal outcomes in women with pregestational diabetes differ by race/ethnicity. These differences are likely multifactorial and require further study. Clinicians can use these data for counseling patients of different heritages.
greater amounts of excess weight gain (Table). Excess weight gain was also associated with increased risk of LGA neonates (aOR 1.57, 95% CI 1.49-1.67, for weight gain >30lbs) but decreased risk of SGA neonates (aOR 0.69, 95% CI 0.66-0.73). Subgroup analyses by BMI class demonstrated similar findings between Class 1, 2, and 3 obese women. CONCLUSION: In the obese and morbidly obese, excess weight gain is associated with increasing risk of adverse maternal and neonatal outcomes. While inadequate weight gain is associated with improved maternal outcomes, it is associated with increased risk of SGA status neonates, suggesting the IOM guideline of 11-20 pound weight gain is appropriate for the obese and morbidly obese.
583 Gestational weight gain in the obese and morbidly obese: how much is too much?
584 Factors associated with failure of initial dietary therapy in women with gestational diabetes
Lynn M. Yee1, Aaron B. Caughey2, Yvonne W. Cheng3 1
Northwestern University Feinberg School of Medicine, Chicago, IL, 2Oregon Health & Science University, Portland, OR, 3University of California, Davis, Sacramento, CA
OBJECTIVE: To examine the relationship between gestational weight gain and perinatal outcomes in a large, population-based cohort of obese and morbidly obese women. STUDY DESIGN: Population-based retrospective cohort study of nulliparous obese (BMI >30) women with term, singleton, vertex births in the U.S. between 2011-2013. Women were categorized as having lost weight, gained 1-10lbs, 11-20lbs (within Institute of Medicine [IOM] guidelines), 21-30lbs, and >30lbs. Chi-square tests and multivariable logistic regression analysis were used for statistical comparisons. RESULTS: In this large birth cohort, 2,372,838 women met criteria for inclusion, of whom 72.8% gained weight in excess of IOM guidelines. Obese women with excess weight gain were more likely to be older, non-White race/ethnicity, married, and have greater education. Compared to obese women who gained 11-20lbs, those who lost weight were less likely to have preeclampsia (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.82-0.90), cesarean delivery (aOR 0.86, 95% CI 0.84-0.88), chorioamnionitis (aOR 0.80, 95% CI 0.74-0.87), or to have neonates who were large-for-gestational (LGA) (aOR 0.82, 95% CI 0.75-0.90). Weight loss was associated with small-for-gestational-age (SGA) neonates (aOR 1.22, 95% CI 1.14-1.30). Women who gained excess weight were at risk of multiple adverse maternal outcomes, including preeclampsia, induction of labor, cesarean delivery, chorioamnionitis, blood transfusion, and unplanned hysterectomy; risk increased with
Maisa Feghali1, John Mission1, Steve Caritis1, Janet Catov1, Christina Scifres2
1 Department of OBGYN and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, 2Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
OBJECTIVE: Women with gestational diabetes (GDM) undergo di-
etary counseling and an initial period of glucose monitoring to determine whether medication is required, but there is a paucity of data regarding what maternal characteristics are associated with failure of dietary therapy. We therefore compared maternal characteristics between women who did or did not achieve adequate glycemic control in the first 7 days of dietary therapy. STUDY DESIGN: We identified 1,176 women with GDM who underwent standardized dietary counseling and reported blood glucose values after an initial 7-day period of glycemic monitoring (mean of 23.3 5.0 blood sugars/patient were reported over this time period). Failed dietary therapy was defined as mean fasting blood sugars 95 mg/dL or mean 1-hour post-meal blood sugar exceeded 140 mg/ dL during the initial trial of dietary therapy. Maternal characteristics and OGTT values were compared between those women who failed dietary management and those who did not using bivariate statistics and multivariable logistic regression modeling. RESULTS: We identified 494/1176 women (42%) who failed initial dietary therapy. Women who failed initial dietary therapy had higher pre-pregnancy BMI, more weight gain prior to diagnosis, and higher fasting, 1 and 2-hour OGTT values. After adjustment for relevant covariates, factors that were most predictive of dietary therapy failure include pre-pregnancy BMI (OR 1.05, 95% CI 1.02-1.07), glucose
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S313
Poster Session IV
control for potential confounders. Outcomes included oligohydramnios, small for gestational age (SGA) <10%, intrauterine fetal demise (IUFD), preterm delivery (PTD), preeclampsia and cesarean delivery. RESULTS: Compared to other groups, Black women with pregestational diabetes had a higher incidence of preeclampsia, SGA <10%, IUFD and PTD. Black and Hispanic women had a higher incidence of oligohydramnios. Asian women with pregestational diabetes had a higher incidence of SGA <10% and lower incidence of preeclampsia and cesarean delivery (Table). This was confirmed in multivariate analyses. The odds ratios for Black women were 1.6 (95%CI 1.1-2.3) for oligohydramnios, 2.3 (95%CI 1.7-3.1) for SGA, 3.7 (95% CI 1.78.1) for IUFD, 1.4 (95% CI 1.1-1.6) for PTD, 1.3 (95% CI 1.0-1.7). The odds ratio for Hispanic women was 1.6 (95% CI 1.2-2.0) for oligohydramnios. The odds ratio for Asian women was 2.2 (95% CI 1.6-2.8) for SGA, 0.7 (95%CI 0.6-0.9) for preeclampsia and 0.6 (95% CI 0.5-0.8) for cesarean. CONCLUSION: Perinatal outcomes in women with pregestational diabetes differ by race/ethnicity. These differences are likely multifactorial and require further study. Clinicians can use these data for counseling patients of different heritages.
greater amounts of excess weight gain (Table). Excess weight gain was also associated with increased risk of LGA neonates (aOR 1.57, 95% CI 1.49-1.67, for weight gain >30lbs) but decreased risk of SGA neonates (aOR 0.69, 95% CI 0.66-0.73). Subgroup analyses by BMI class demonstrated similar findings between Class 1, 2, and 3 obese women. CONCLUSION: In the obese and morbidly obese, excess weight gain is associated with increasing risk of adverse maternal and neonatal outcomes. While inadequate weight gain is associated with improved maternal outcomes, it is associated with increased risk of SGA status neonates, suggesting the IOM guideline of 11-20 pound weight gain is appropriate for the obese and morbidly obese.
583 Gestational weight gain in the obese and morbidly obese: how much is too much?
584 Factors associated with failure of initial dietary therapy in women with gestational diabetes
Lynn M. Yee1, Aaron B. Caughey2, Yvonne W. Cheng3 1
Northwestern University Feinberg School of Medicine, Chicago, IL, 2Oregon Health & Science University, Portland, OR, 3University of California, Davis, Sacramento, CA
OBJECTIVE: To examine the relationship between gestational weight gain and perinatal outcomes in a large, population-based cohort of obese and morbidly obese women. STUDY DESIGN: Population-based retrospective cohort study of nulliparous obese (BMI >30) women with term, singleton, vertex births in the U.S. between 2011-2013. Women were categorized as having lost weight, gained 1-10lbs, 11-20lbs (within Institute of Medicine [IOM] guidelines), 21-30lbs, and >30lbs. Chi-square tests and multivariable logistic regression analysis were used for statistical comparisons. RESULTS: In this large birth cohort, 2,372,838 women met criteria for inclusion, of whom 72.8% gained weight in excess of IOM guidelines. Obese women with excess weight gain were more likely to be older, non-White race/ethnicity, married, and have greater education. Compared to obese women who gained 11-20lbs, those who lost weight were less likely to have preeclampsia (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.82-0.90), cesarean delivery (aOR 0.86, 95% CI 0.84-0.88), chorioamnionitis (aOR 0.80, 95% CI 0.74-0.87), or to have neonates who were large-for-gestational (LGA) (aOR 0.82, 95% CI 0.75-0.90). Weight loss was associated with small-for-gestational-age (SGA) neonates (aOR 1.22, 95% CI 1.14-1.30). Women who gained excess weight were at risk of multiple adverse maternal outcomes, including preeclampsia, induction of labor, cesarean delivery, chorioamnionitis, blood transfusion, and unplanned hysterectomy; risk increased with
Maisa Feghali1, John Mission1, Steve Caritis1, Janet Catov1, Christina Scifres2
1 Department of OBGYN and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, 2Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
OBJECTIVE: Women with gestational diabetes (GDM) undergo di-
etary counseling and an initial period of glucose monitoring to determine whether medication is required, but there is a paucity of data regarding what maternal characteristics are associated with failure of dietary therapy. We therefore compared maternal characteristics between women who did or did not achieve adequate glycemic control in the first 7 days of dietary therapy. STUDY DESIGN: We identified 1,176 women with GDM who underwent standardized dietary counseling and reported blood glucose values after an initial 7-day period of glycemic monitoring (mean of 23.3 5.0 blood sugars/patient were reported over this time period). Failed dietary therapy was defined as mean fasting blood sugars 95 mg/dL or mean 1-hour post-meal blood sugar exceeded 140 mg/ dL during the initial trial of dietary therapy. Maternal characteristics and OGTT values were compared between those women who failed dietary management and those who did not using bivariate statistics and multivariable logistic regression modeling. RESULTS: We identified 494/1176 women (42%) who failed initial dietary therapy. Women who failed initial dietary therapy had higher pre-pregnancy BMI, more weight gain prior to diagnosis, and higher fasting, 1 and 2-hour OGTT values. After adjustment for relevant covariates, factors that were most predictive of dietary therapy failure include pre-pregnancy BMI (OR 1.05, 95% CI 1.02-1.07), glucose
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S313