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O306 MANAGEMENT OF NEPHROTIC SYNDROME IN PREGNANCY
S368
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
CAPP devices (PASG and NASG) are increasingly being used in low resource settings by mid-level obstetric providers. It is not known how much provider skill deteriorates after training or how much the devices decrease pelvic blood flow in a real world situation. Materials: Twelve auxiliary nurse midwives (with 18 months of training) and obstetric staff nurses were given a three hour review of PPH. As part of the training they were taught to apply a low cost PASG designed for use in low resource countries and a commercial (ZOEX TM) NASG. After eight months participants re-applied the devices in groups of three (one participant served as subject, one applied the device, and the third assisted). Methods: Performance was tested by measuring distal aortic blood flow immediately below the superior mesenteric artery takeoff with an ultrasound, before and after device placement. Data were analyzed using paired t tests. Results: Mean baseline blood flow was 1.55 l/min SD 0.47 l/min. The mean difference from baseline for the PASG was 29% (95% CI 15–42) P = 0.002. For the NASG the mean difference from baseline was 14% (95% CI 5–33) P = 0.09. This is markedly less than the previously published flow decrease of 56% for PASG and 33% for the NASG obtained under more standardized conditions. Conclusions: Performance by clinical providers eight months after training was considerably less than optimal. We have modified the PASG to make it simpler to use but suggest that refresher training might be needed in addition. The MicroMaxx® ultrasounds were provided by SonoSite Inc. O305 EFFECTS OF ABORTION LEGALIZATION IN NEPAL, 2001–2010 J.T. Henderson1 , M. Puri2 , K. Malla7 , A. Rana3 , S. Sharma4 , C.C. Harper1 , D. Grossman5 , M. Blum1 , P. Lamichhane2 , D. Thogra6 , P.D. Darney1 . 1 University of California, San Francisco, Bixby Center for Global Reproductive Health, San Francisco, CA, United States; 2 Center for Research on Environment Health & Population Activities, Kusunti, Lalitpur, Kathmandu, Nepal; 3 Tribhuvan University Teaching Hospital, Kathmandu, Nepal; 4 Nepal Ministry of Health, Kathmandu, Nepal; 5 Ibis Reproductive Health, San Francisco, CA, United States; 6 San Francisco, CA, United States; 7 Kathmandu, Nepal Objectives: Abortion was legalized in Nepal in 2002, and in April 2004 legal services commenced. Since then, a nationwide program to train abortion providers and regulate the safety and availability of services has dramatically expanded access to safe abortion. These changes were expected to reduce high morbidity and mortality from unsafe abortion in the country. To test the effects of legalization on women’s health, we monitored the trend in abortion complications treated at sentinel hospitals. Materials: All abortion cases presenting at three large tertiary care hospitals were reviewed for our study. Patient medical charts were retrospectively abstracted for all women admitted with abortion (spontaneous and induced) or medical complications related to abortion during the years 2001–2010. Research staff identified eligible charts and abstracted data using standardized protocols and forms (n = 22,586). Methods: High severity abortion complications were defined as those with evidence of serious infection, injury, or systemic complications. A variable was constructed to indicate the likelihood that the case was induced, based on information in the medical chart and signs of instrumentation. Interrupted-time series analysis using segmented Poisson regression analysis was conducted to account for underlying and seasonal trends. Results: A significant decrease in the incidence of high severity abortions was observed in the period following implementation of the legal abortion policy (p < 0.001). Following legalization more abortion complication cases presented to the hospitals overall. Tests for differences in the trend slope indicate that the reduction in high severity cases became more pronounced in late 2007. Additional
analyses of rural urban differences in complications will also be presented. Conclusions: The decline in severe complications seen at major tertiary care hospitals suggests that the legalization of abortion has contributed to recent reductions in maternal mortality observed in Nepal. These findings highlight the importance of legalization and safe service expansion as an approach for reducing maternal morbidity and mortality in other settings where women have limited access to safe abortion. The legalization of abortion in Nepal was motivated by global public health efforts to reduce unsafe abortion, a significant contributor to maternal mortality. Results from this study contribute to the literature suggesting a causal link between abortion legalization and improvements in maternal health.
O306 MANAGEMENT OF NEPHROTIC SYNDROME IN PREGNANCY A.J. Hill1 , D.E. Stone2 , C. Cook2 , R. Gerkin2 , M. Ingersoll2 , J. Elliott3 . 1 Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, TX, United States; 2 Banner Good Samaritan Medical Center, Phoenix, AZ, United States; 3 Saddleback Memorial Medical Center, Laguna Hills, CA, United States Objectives: With advances in prenatal care, clinicians are caring for more pregnant patients with renal insufficiency. Documented strategies to guide the management of patients with severe renal insufficiency, such as nephrotic syndrome (NS), are limited. We review the management and outcomes of eleven patients in an effort to improve counseling and treatment. Materials: After approval from the Institutional Review Board, medical records from two Arizona hospitals (Banner Good Samaritan Medical Center and Banner Desert Hospital) were reviewed. Methods: A retrospective cohort of 11 patients with NS, defined as proteinuria >3.5g/24hr, edema, and albumin <3g/dL, was performed from January 2009 to January 2011. Treatment regimens and trends were recorded and analyzed. Results: Eleven patients were diagnosed by the above criteria: 10 at initial presentation, 1 after a repeat urine collection. Mean baseline 24-hour protein was 10g [2.5–36.6g] and increased to 26g [4.6–49.9g] when repeated in 6 patients. On first antepartum (AP) admission, 3 of 11 individuals had a creatinine >1.4mg/dL, and all exhibited an increase in the AP period. Two women required AP dialysis, which continued postpartum (PP), and one additional woman required PP dialysis. Pregravid weight increased on average 17 kg [3.6–36.8 kg] to the time of delivery, with decreased weights during AP admissions for diuresis. Mean diuresis was 33.2L (±25.8) AP and 5.1L (±8.2) PP. Albumin levels were <1.0g/dL for 3 patients; the remaining averaged 2g/dL (±0.5). Ten patients received IV diuretics, and 9 received IV albumin. Gestational age at delivery averaged 33.3 weeks [ranging 26–38.4 weeks]. Comorbidities included chronic hypertension (10 patients, all on antihypertensive agents, 7 requiring additional agents) and pregestational diabetes (8 patients). Six individuals received anticoagulation. There were 0
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
maternal deaths, 1 unexplained <500g fetal demise, and 1 neonatal demise due to a congenital cardiac anomaly incompatible with life. Conclusions: Pregnant patients with NS can safely be diuresed and managed by experienced obstetricians and nephrologists with an overall positive fetal outcome. A regimen of carefully monitored diuresis, repletion of albumin, and administration of anticoagulants when necessary is a promising management strategy for such patients, who often present with multiple comorbidities. O307 MATERNAL AND NEONATAL OUTCOMES FROM EXTREMELY PREMATURE PRETERM RUPTURE OF MEMBRANES A.J. Hill1 , J. Willms3 , R. Gerkin2 , M. Ingersoll2 , G.K. Lam4 . 1 Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, TX, United States; 2 Banner Good Samaritan Medical Center, Phoenix, AZ, United States; 3 University of Texas Southwestern Medical Branch, Dallas, TX, United States; 4 University of Tennessee at Chattanooga, Chattanooga, TN, United States Objectives: Preterm Premature Rupture of Membranes (PPROM) is associated with 30% of preterm deliveries, making it an important cause of perinatal morbidity and mortality. The management of PPROM is controversial, especially as it relates to patients with PPROM prior to viability. Counseling patients with such extreme PPROM (ePPROM) is difficult due to lack of evidence regarding latency periods, maternal risks, and neonatal outcomes. The purpose of this study was to review significant events in the clinical course of women continuing pregnancy after ePPROM and characterize subsequent neonatal outcomes. Materials: From January 2004 to December 2009 we identified patients with PPROM from 14 0/7 to 24 6/7 weeks’ gestation from electronic medical records at two Phoenix hospitals (Banner Good Samaritan Medical Center and Banner Desert Hospital) that perform a combined 14,000 deliveries per year. Methods: One hundred and four women were identified, and those who chose pregnancy termination or were found with immediate fetal demise were excluded. Thirty-one pregnancies were evaluated. Independent t-tests were used to determine differences in factors of neonatal survival. Outcomes (Expressed as Means) of Neonates Admitted to the NICU*
GA at delivery (wk) Latency period (d) Days in NICU Days on ventilator RDS IVH Pulmonary Hypoplasia Weight (g)
13 survivors
5 neonatal deaths
28.9 54.0 74.5 16.9 12 8 2 1311
26.3 21.6 24.6 14.6 5 4 3 981
* Excludes 2/23 infants that had no NICU stay, and 3 with immediate neonatal demise. Key: GA, gestational age; wk, weeks; d, days; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome; IVH, intraventricular hemorrhage; g, grams
Results: Regarding maternal outcomes, 4/31 women underwent amniocentesis for clinical suspicion of chorioamnionitis (CA) and none indicated infection. One woman who did not undergo amniocentesis became septic from CA and one patient experienced postpartum wound infection. Mean length of latency from ePPROM to delivery of the 23 live-born infants was 48.6 days. Regarding neonatal outcomes, 8/31 were stillborn, and of the remaining 23, two did not require NICU admission, three demised immediately after birth from extreme prematurity, and the remaining 18 experienced prolonged NICU admissions, averaging 47.8 days. Five of these 18 neonates demised in the NICU. Relevant outcomes of the surviving infants are described in the table below. Overall, 15/23 live-born infants (65%) were discharged home after experiencing ePPROM.
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Conclusions: Women with ePPROM are capable of prolonging pregnancy for a significant period of time to allow continued fetal development, without high risk of CA or sepsis. Approximately 2/3 of affected women are able to take their infants home. A larger study size is needed to identify neonatal predictors of survival rate, and ideally an assessment of long-term neonatal outcomes is needed. O308 GESTATIONAL DIABETES IN VIETNAM: LITTLE KNOWLEDGE MAY BE A DANGEROUS THING J.E. Hirst1 , T.S. Tran2 , M.A.T. Do2 , J.M. Morris1 , H.E. Jeffery3 . 1 Obstetrics & Gynaecology, University of Sydney, St Leonards, NSW, Australia; 2 Hung Vuong Hospital, Ho Chi Minh City, HCMC, Viet Nam; 3 University of Sydney, Camperdown, NSW, Australia Objectives: Gestational diabetes mellitus is becoming increasingly common in Asia and the impact on women has not been well studied. We aimed to determine the health beliefs of women with GDM in Vietnam. Materials: Setting: Hung Vuong Hospital, Ho Chi Minh City. Women with GDM were purposely recruited from the outpatient and inpatient departments. Four focus groups were conducted by an experienced facilitator in Vietnamese and independently translated and transcribed into English. The sessions lasted around 1 hour and were semi structured. Participation was voluntary. Women gave informed consent and received no remuneration. Methods: Transcripts were entered into NVivo9 and data analysed thematically. Major themes were: feelings about diagnosis and diet, beliefs about GDM, attitudes towards breast feeding and sources of health information. Results: From December 2010 to February 2011, four focus groups involving 30 women were conducted. The median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. One third of women were receiving insulin. When asked about their diagnosis, women expressed anxiety, with ‘worry’ and ‘afraid’ being common words used. Many women expressed feelings of guilt. The major concerns were around the diet, with fears about consuming particular food types and the quantity of food repeatedly mentioned. As a result many women reported being ‘hungry’ or ‘starving’ most of the time. Many women felt that severe restriction of intake was the best way to control blood glucose levels. Whilst some women had good knowledge of the effects of GDM on the baby, others felt their baby was at greatly increased risk of death. There was concern from some women about transmission of GDM to the baby through breast milk, with several women stating they were either uncertain or would not breast feed. All women felt they wanted more information. Women sought information mostly from friends, magazines or the Internet. They felt small group sessions with an experienced clinician and detailed leaflets describing the recommended dietary changes would be beneficial. Conclusions: Women with GDM in Vietnam felt that they lacked information and this created anxiety and misconceptions about their diagnosis. Several women reported dangerous restrictions in dietary intake for fear of high blood glucose levels. This study highlights the need for sustainable, culturally appropriate health promotion activities for this population. O309 EARLY PREDICTION OF GESTATIONAL DIABETES IN VIETNAM: THE IMPACT OF CURRENTLY RECOMMENDED DIAGNOSIS CRITERIA T.S. Tran1 , J.E. Hirst3 , M.A.T. Do2 , J.M. Morris3 , H.E. Jeffery4 . 1 Discipline of ObGyn, School of Paediatrics and Reproductive Health, Australian Research Center for Health of Women and Babies, Adelaide, SA, Australia; 2 Hung Vuong Hospital, Ho Chi Minh, Ho Chi Minh, Viet Nam; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 4 Royal Prince Alfred Hospital, Sydney, NSW, Australia Objectives: A widely accepted diagnosis criterion of gestational diabetes mellitus (GDM) is not available, though the appropriate
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
CAPP devices (PASG and NASG) are increasingly being used in low resource settings by mid-level obstetric providers. It is not known how much provider skill deteriorates after training or how much the devices decrease pelvic blood flow in a real world situation. Materials: Twelve auxiliary nurse midwives (with 18 months of training) and obstetric staff nurses were given a three hour review of PPH. As part of the training they were taught to apply a low cost PASG designed for use in low resource countries and a commercial (ZOEX TM) NASG. After eight months participants re-applied the devices in groups of three (one participant served as subject, one applied the device, and the third assisted). Methods: Performance was tested by measuring distal aortic blood flow immediately below the superior mesenteric artery takeoff with an ultrasound, before and after device placement. Data were analyzed using paired t tests. Results: Mean baseline blood flow was 1.55 l/min SD 0.47 l/min. The mean difference from baseline for the PASG was 29% (95% CI 15–42) P = 0.002. For the NASG the mean difference from baseline was 14% (95% CI 5–33) P = 0.09. This is markedly less than the previously published flow decrease of 56% for PASG and 33% for the NASG obtained under more standardized conditions. Conclusions: Performance by clinical providers eight months after training was considerably less than optimal. We have modified the PASG to make it simpler to use but suggest that refresher training might be needed in addition. The MicroMaxx® ultrasounds were provided by SonoSite Inc. O305 EFFECTS OF ABORTION LEGALIZATION IN NEPAL, 2001–2010 J.T. Henderson1 , M. Puri2 , K. Malla7 , A. Rana3 , S. Sharma4 , C.C. Harper1 , D. Grossman5 , M. Blum1 , P. Lamichhane2 , D. Thogra6 , P.D. Darney1 . 1 University of California, San Francisco, Bixby Center for Global Reproductive Health, San Francisco, CA, United States; 2 Center for Research on Environment Health & Population Activities, Kusunti, Lalitpur, Kathmandu, Nepal; 3 Tribhuvan University Teaching Hospital, Kathmandu, Nepal; 4 Nepal Ministry of Health, Kathmandu, Nepal; 5 Ibis Reproductive Health, San Francisco, CA, United States; 6 San Francisco, CA, United States; 7 Kathmandu, Nepal Objectives: Abortion was legalized in Nepal in 2002, and in April 2004 legal services commenced. Since then, a nationwide program to train abortion providers and regulate the safety and availability of services has dramatically expanded access to safe abortion. These changes were expected to reduce high morbidity and mortality from unsafe abortion in the country. To test the effects of legalization on women’s health, we monitored the trend in abortion complications treated at sentinel hospitals. Materials: All abortion cases presenting at three large tertiary care hospitals were reviewed for our study. Patient medical charts were retrospectively abstracted for all women admitted with abortion (spontaneous and induced) or medical complications related to abortion during the years 2001–2010. Research staff identified eligible charts and abstracted data using standardized protocols and forms (n = 22,586). Methods: High severity abortion complications were defined as those with evidence of serious infection, injury, or systemic complications. A variable was constructed to indicate the likelihood that the case was induced, based on information in the medical chart and signs of instrumentation. Interrupted-time series analysis using segmented Poisson regression analysis was conducted to account for underlying and seasonal trends. Results: A significant decrease in the incidence of high severity abortions was observed in the period following implementation of the legal abortion policy (p < 0.001). Following legalization more abortion complication cases presented to the hospitals overall. Tests for differences in the trend slope indicate that the reduction in high severity cases became more pronounced in late 2007. Additional
analyses of rural urban differences in complications will also be presented. Conclusions: The decline in severe complications seen at major tertiary care hospitals suggests that the legalization of abortion has contributed to recent reductions in maternal mortality observed in Nepal. These findings highlight the importance of legalization and safe service expansion as an approach for reducing maternal morbidity and mortality in other settings where women have limited access to safe abortion. The legalization of abortion in Nepal was motivated by global public health efforts to reduce unsafe abortion, a significant contributor to maternal mortality. Results from this study contribute to the literature suggesting a causal link between abortion legalization and improvements in maternal health.
O306 MANAGEMENT OF NEPHROTIC SYNDROME IN PREGNANCY A.J. Hill1 , D.E. Stone2 , C. Cook2 , R. Gerkin2 , M. Ingersoll2 , J. Elliott3 . 1 Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, TX, United States; 2 Banner Good Samaritan Medical Center, Phoenix, AZ, United States; 3 Saddleback Memorial Medical Center, Laguna Hills, CA, United States Objectives: With advances in prenatal care, clinicians are caring for more pregnant patients with renal insufficiency. Documented strategies to guide the management of patients with severe renal insufficiency, such as nephrotic syndrome (NS), are limited. We review the management and outcomes of eleven patients in an effort to improve counseling and treatment. Materials: After approval from the Institutional Review Board, medical records from two Arizona hospitals (Banner Good Samaritan Medical Center and Banner Desert Hospital) were reviewed. Methods: A retrospective cohort of 11 patients with NS, defined as proteinuria >3.5g/24hr, edema, and albumin <3g/dL, was performed from January 2009 to January 2011. Treatment regimens and trends were recorded and analyzed. Results: Eleven patients were diagnosed by the above criteria: 10 at initial presentation, 1 after a repeat urine collection. Mean baseline 24-hour protein was 10g [2.5–36.6g] and increased to 26g [4.6–49.9g] when repeated in 6 patients. On first antepartum (AP) admission, 3 of 11 individuals had a creatinine >1.4mg/dL, and all exhibited an increase in the AP period. Two women required AP dialysis, which continued postpartum (PP), and one additional woman required PP dialysis. Pregravid weight increased on average 17 kg [3.6–36.8 kg] to the time of delivery, with decreased weights during AP admissions for diuresis. Mean diuresis was 33.2L (±25.8) AP and 5.1L (±8.2) PP. Albumin levels were <1.0g/dL for 3 patients; the remaining averaged 2g/dL (±0.5). Ten patients received IV diuretics, and 9 received IV albumin. Gestational age at delivery averaged 33.3 weeks [ranging 26–38.4 weeks]. Comorbidities included chronic hypertension (10 patients, all on antihypertensive agents, 7 requiring additional agents) and pregestational diabetes (8 patients). Six individuals received anticoagulation. There were 0
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
maternal deaths, 1 unexplained <500g fetal demise, and 1 neonatal demise due to a congenital cardiac anomaly incompatible with life. Conclusions: Pregnant patients with NS can safely be diuresed and managed by experienced obstetricians and nephrologists with an overall positive fetal outcome. A regimen of carefully monitored diuresis, repletion of albumin, and administration of anticoagulants when necessary is a promising management strategy for such patients, who often present with multiple comorbidities. O307 MATERNAL AND NEONATAL OUTCOMES FROM EXTREMELY PREMATURE PRETERM RUPTURE OF MEMBRANES A.J. Hill1 , J. Willms3 , R. Gerkin2 , M. Ingersoll2 , G.K. Lam4 . 1 Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, TX, United States; 2 Banner Good Samaritan Medical Center, Phoenix, AZ, United States; 3 University of Texas Southwestern Medical Branch, Dallas, TX, United States; 4 University of Tennessee at Chattanooga, Chattanooga, TN, United States Objectives: Preterm Premature Rupture of Membranes (PPROM) is associated with 30% of preterm deliveries, making it an important cause of perinatal morbidity and mortality. The management of PPROM is controversial, especially as it relates to patients with PPROM prior to viability. Counseling patients with such extreme PPROM (ePPROM) is difficult due to lack of evidence regarding latency periods, maternal risks, and neonatal outcomes. The purpose of this study was to review significant events in the clinical course of women continuing pregnancy after ePPROM and characterize subsequent neonatal outcomes. Materials: From January 2004 to December 2009 we identified patients with PPROM from 14 0/7 to 24 6/7 weeks’ gestation from electronic medical records at two Phoenix hospitals (Banner Good Samaritan Medical Center and Banner Desert Hospital) that perform a combined 14,000 deliveries per year. Methods: One hundred and four women were identified, and those who chose pregnancy termination or were found with immediate fetal demise were excluded. Thirty-one pregnancies were evaluated. Independent t-tests were used to determine differences in factors of neonatal survival. Outcomes (Expressed as Means) of Neonates Admitted to the NICU*
GA at delivery (wk) Latency period (d) Days in NICU Days on ventilator RDS IVH Pulmonary Hypoplasia Weight (g)
13 survivors
5 neonatal deaths
28.9 54.0 74.5 16.9 12 8 2 1311
26.3 21.6 24.6 14.6 5 4 3 981
* Excludes 2/23 infants that had no NICU stay, and 3 with immediate neonatal demise. Key: GA, gestational age; wk, weeks; d, days; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome; IVH, intraventricular hemorrhage; g, grams
Results: Regarding maternal outcomes, 4/31 women underwent amniocentesis for clinical suspicion of chorioamnionitis (CA) and none indicated infection. One woman who did not undergo amniocentesis became septic from CA and one patient experienced postpartum wound infection. Mean length of latency from ePPROM to delivery of the 23 live-born infants was 48.6 days. Regarding neonatal outcomes, 8/31 were stillborn, and of the remaining 23, two did not require NICU admission, three demised immediately after birth from extreme prematurity, and the remaining 18 experienced prolonged NICU admissions, averaging 47.8 days. Five of these 18 neonates demised in the NICU. Relevant outcomes of the surviving infants are described in the table below. Overall, 15/23 live-born infants (65%) were discharged home after experiencing ePPROM.
S369
Conclusions: Women with ePPROM are capable of prolonging pregnancy for a significant period of time to allow continued fetal development, without high risk of CA or sepsis. Approximately 2/3 of affected women are able to take their infants home. A larger study size is needed to identify neonatal predictors of survival rate, and ideally an assessment of long-term neonatal outcomes is needed. O308 GESTATIONAL DIABETES IN VIETNAM: LITTLE KNOWLEDGE MAY BE A DANGEROUS THING J.E. Hirst1 , T.S. Tran2 , M.A.T. Do2 , J.M. Morris1 , H.E. Jeffery3 . 1 Obstetrics & Gynaecology, University of Sydney, St Leonards, NSW, Australia; 2 Hung Vuong Hospital, Ho Chi Minh City, HCMC, Viet Nam; 3 University of Sydney, Camperdown, NSW, Australia Objectives: Gestational diabetes mellitus is becoming increasingly common in Asia and the impact on women has not been well studied. We aimed to determine the health beliefs of women with GDM in Vietnam. Materials: Setting: Hung Vuong Hospital, Ho Chi Minh City. Women with GDM were purposely recruited from the outpatient and inpatient departments. Four focus groups were conducted by an experienced facilitator in Vietnamese and independently translated and transcribed into English. The sessions lasted around 1 hour and were semi structured. Participation was voluntary. Women gave informed consent and received no remuneration. Methods: Transcripts were entered into NVivo9 and data analysed thematically. Major themes were: feelings about diagnosis and diet, beliefs about GDM, attitudes towards breast feeding and sources of health information. Results: From December 2010 to February 2011, four focus groups involving 30 women were conducted. The median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. One third of women were receiving insulin. When asked about their diagnosis, women expressed anxiety, with ‘worry’ and ‘afraid’ being common words used. Many women expressed feelings of guilt. The major concerns were around the diet, with fears about consuming particular food types and the quantity of food repeatedly mentioned. As a result many women reported being ‘hungry’ or ‘starving’ most of the time. Many women felt that severe restriction of intake was the best way to control blood glucose levels. Whilst some women had good knowledge of the effects of GDM on the baby, others felt their baby was at greatly increased risk of death. There was concern from some women about transmission of GDM to the baby through breast milk, with several women stating they were either uncertain or would not breast feed. All women felt they wanted more information. Women sought information mostly from friends, magazines or the Internet. They felt small group sessions with an experienced clinician and detailed leaflets describing the recommended dietary changes would be beneficial. Conclusions: Women with GDM in Vietnam felt that they lacked information and this created anxiety and misconceptions about their diagnosis. Several women reported dangerous restrictions in dietary intake for fear of high blood glucose levels. This study highlights the need for sustainable, culturally appropriate health promotion activities for this population. O309 EARLY PREDICTION OF GESTATIONAL DIABETES IN VIETNAM: THE IMPACT OF CURRENTLY RECOMMENDED DIAGNOSIS CRITERIA T.S. Tran1 , J.E. Hirst3 , M.A.T. Do2 , J.M. Morris3 , H.E. Jeffery4 . 1 Discipline of ObGyn, School of Paediatrics and Reproductive Health, Australian Research Center for Health of Women and Babies, Adelaide, SA, Australia; 2 Hung Vuong Hospital, Ho Chi Minh, Ho Chi Minh, Viet Nam; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 4 Royal Prince Alfred Hospital, Sydney, NSW, Australia Objectives: A widely accepted diagnosis criterion of gestational diabetes mellitus (GDM) is not available, though the appropriate