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95: Body fat index: A novel alternative to body

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Conference Paper in American journal of obstetrics and gynecology · January 2016

DOI: 10.1016/j.ajog.2015.10.116

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Poster Session I
future, this could potentially facilitate early aspirin prophylaxis
against SB, and requires further investigation.
133 Timing of delivery in pregnancies complicated by
diabetes
Lorie M. Harper, Alan TN. Tita, Joseph R. Biggio, John C. Hauth,
Jen Jen Chang
1
University of Alabama at Birmingham, Center for Women’s Reproductive
Health, Birmingham, AL, 2Department of Epidemiology, Saint Louis
University College for Public health and Social Justice, St. Louis, MO
OBJECTIVE: As current recommendations are based on expert
opinion we aimed to determine the optimal timing of delivery in
pregnancies complicated by diabetes (DM) to minimize perinatal
death and severe adverse events.
STUDY DESIGN: Population-based cohort of all singleton, non-
anomalous infants of diabetic pregnancies in the Missouri mater-
nally linked birth registry 1989-2005. Only the first qualifying
pregnancy in the cohort was considered. Perinatal outcomes of
planned deliveries at 37, 38, 39, and 40 weeks were compared to
expectant management beyond each gestational age period. Planned
deliveries were identified by induction or cesarean delivery without
documented medical or obstetric indications of stillbirth, pre-
eclampsia/eclampsia, hydramnios, or spontaneous labor. The pri-
mary outcome was perinatal death. Secondary outcomes were
stillbirth, neonatal death, and a composite adverse neonatal event of
assisted ventilation >30 minutes, birth injury, seizures, or 5-minute
Apgar
3. Groups were compared using Student’s t-test and chi-
squared as appropriate.
RESULTS: In 5,309 diabetic pregnancies reaching 36 weeks, 1,122
(21.1%) were insulin dependent (IDDM). The risk of perinatal death
at any gestational age examined was low (<4/1,000), as was the risk
of the adverse perinatal outcome (<2%). When only IDDM were
included, the risk of perinatal death at any gestational age was
nominally higher, although remained <7/1000. The risk of adverse
neonatal events in IDDM increased to 2.7% with expectant man-
agement beyond 40 weeks, although this difference did not reach
statistical significance. In insulin-dependent diabetics, a planned
delivery at 37 weeks could prevent 5-6 perinatal deaths/1,000,
without significant increases in adverse neonatal events.
CONCLUSION: Delivery as early as 37 weeks may be a reasonable
option in pregnancies complicated by diabetes, although the absolute
risk of perinatal death and adverse neonatal outcomes is low at every
gestational age. Further well-powered studies that can take into
consideration diabetic control are needed.
S90 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
ajog.org
134 Utility of ultrasound measurement of maternal visceral
and parietal fat for prediction of gestational diabetes
Ahmed A. Nassr, Sherif A. Shazly, Mari C. Trinindad,
Sherif A. El-Nashar, Amber M. Marroquin, Brian C. Brost
1
Mayo Clinic College of Medicine, Rochester, MN, 2Women’s Health
Hospital, Assiut University, Assiut, Egypt, 3Wake Forest School of Medicine,
Winston Salem, NC
OBJECTIVE: To evaluate the utility of ultrasound measurement of
visceral and parietal fat along with clinical characteristics as an early
screening tool for gestational diabetes (GDM).
STUDY DESIGN: A prospective study of non-diabetic women under-
going fetal anatomic survey between 18-24 weeks gestation was
performed between September 2014 and March 2015. Baseline
characteristics were collected prior to anatomic survey and parietal
and visceral fat thicknesses were measured. Women were followed by
routine glucose screening tests and GDM was diagnosed according
to ACOG guidelines. Multivariate logistic regression with boot-
strapping was used to test potential predictors based on univariate
analysis. Receiver operating characteristic (ROC) were used to select
the cut point for continuous variables.
RESULTS: Of the 412 eligible women, 389 women met study criteria.
Their mean age was 29.7  4.67 years. Median and interquartile
range (IQR) for parity were 1 (0-2), BMI were 25.1 (21.9 - 30.3) and
parietal fat and visceral fat measurements were 12 (9-16) mm and 11
(8-14) mm respectively. Positive family history was reported in 43%
of patients while 4.4% had past history of GDM. On multivariate
analysis, positive family history (adjusted odds ratio “aOR” 2.30,
95% CI 1.35-3.92), Past history of GDM (aOR 6.87, 95% CI 3.03 -
15.61), parietal fat  13 mm (aOR 4.63, 95% CI 1.60-13.38) and
visceral fat  9 mm (aOR 3.32, 95% CI 1.06-10.42) were significant.
Expected predictability of the model ranges from 0.9% when all
predictors are negative to 69.5% when they are all positive. Post-
estimation analysis supports model fitness.
CONCLUSION: Ultrasound measurement of parietal and visceral fat at
time of fetal anatomic survey seems to be a good predictor for
development of GDM. We also suggest that a model that consists of
family history and past history of GDM, parietal and visceral fat
measurement could predict GDM early without additional costs and
may help to select women in whom glucose tolerance testing is
warranted.
ajog.org
135 Correlation of maternal diabetes with septal and
ventricular wall thickness in first generational progeny
Rolanda Lister, Francine Hughes Einstein, Peer Dar, Bin Zhou
1
Albert Einstein College of Medicine, Bronx, NY, 2Department of Obstetrics
& Gynecology and Womens Health, Albert Einstein College of Medicine/
Montefiore Medical Center, Bronx, NY
OBJECTIVE: To compare the interventricular septum and left ven-
tricular wall thickness of fetuses exposed to maternal hyperglycemia
with and without congenital heart defects versus controls.
STUDY DESIGN: Eight week old CD-1 wild type mice were adminis-
tered a single dose of 150mg/kg of streptozotocin (STZ) via intra-
peritoneal injection to induce diabetes. Control females were given
an equal volume of Sodium Citrate. Hyperglycemia was defined as
mean fasting blood glucose >200 mg/dL. All females were mated
with normal male CD-1 mice. Histological analysis of fetal heart
morphology was evaluated for malformations on embryonic day 16.
Width of interventricular septum and ventricular wall were
measured at the mid-section of the heart perpendicular to cardiac
axis at the level of the atrioventricular valves at 5x magnification
using a high resolution microscope. Student t-test was employed to
compare the widths of the interventricular septum and left ven-
tricular wall between those exposed to hyperglycemia and controls.
Hearts with congenital heart defects were compared with normal
hearts. P-value < 0.05 was considered significant.
RESULTS: Neither the ventricular wall thickness (28.11mM +/- 5.86
mM vs 27.95 mM +/- 8.58 mM; p¼0.50) nor the interventricular
septal width (43.75 mM +/- 10.34 mM vs 43.47 mM +/-14.27 mM;
p¼0.65) differed between hearts of fetuses exposed to hyperglycemia
and controls. When stratifying for congenital heart defects or degree
of hyperglycemia, there still remained no difference in the widths of
interventricular septal wall thickness or the left ventricular wall
thickness.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
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Poster Session I
CONCLUSION: Despite the known association between prenatal car-
diac hypertrophy and maternal diabetes, in this murine model of
diabetes in pregnancy the width of the septal or ventricular wall were
not significantly different between fetuses exposed to maternal hy-
perglycemia and those who were not exposed. Presence of congenital
heart defects did not modify these findings.
136 Gestational diabetes mellitus: An independent risk
factor for long- term pediatric endocrine morbidity of the
offspring
Hanaa Abokaf, Ilana Shoham-Vardi, Roslan Sergeinko,
Efrat Spiegel, Danielle Landau, Eyal Sheiner
1
Department of Obstetrics and Gynecology, Soroka University Medical
Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer
Sheva, Israel, 2Department of Public Health, Faculty of Health Sciences, Ben-
Gurion University of the Negev, Beer Sheva, Israel, 3Department of Pediatrics,
Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion
university of the Negev, Beer Sheva, Israel
OBJECTIVE: To assess whether in utero exposure to gestational dia-
betes mellitus (GDM) increases the risk for long-term endocrine
morbidity of the offspring.
STUDY DESIGN: A retrospective population-based cohort study
compared long-term (up to the age of 18 years) hospitalized pedi-
atric endocrine morbidity between singletons prenatally exposed and
unexposed to GDM. Deliveries occurred between the years 1991-
2014 in a regional tertiary medical center. The exposure variables
were diet-controlled GDM (GDMA1) and treated GDM (GDMA2).
Mothers with pre-gestational diabetes mellitus, and infants with
congenital malformations were excluded from the study. Kaplan-
Meier survival curve was used to estimate cumulative incidence of
endocrine morbidity. A multivariate generalized estimating equation
(GEE) logistic regression model analysis was used to control for
confounders and for maternal clusters.
RESULTS: During the study period 256,270 deliveries met the in-
clusion criteria, of which 5.0% were diagnosed with GDM
(n¼12,889). During the follow-up period, children exposed in utero
to GDM had a higher rate of long- term endocrine morbidity, and
specifically higher rate of overweight and obesity compared to those
unexposed (table). Children born to women with GDM had higher
cumulative incidence of endocrine morbidity (Kaplan-Meier survival
curves; figure). Using a multivariable GEE logistic regression model,
controlling for maternal age, gestational age at delivery, birthweight
and the time to event, in utero exposure to GDMA1 (adjusted OR
¼2.1; 95% CI 1.7-2.7; P<0.001) and to GDMA2 (adjusted OR
¼3.08; 95% CI 2.1-4.4, P<0.001) were found as independent risk
factors for long-term endocrine disease during childhood.
CONCLUSION: Exposure to maternal GDM is an independent risk
factor for long-term endocrine morbidity of the offspring.
S91