Pregravid BMI Research Articles

Human Milk Components and the Infant Gut Microbiome at 6 Months: Understanding the Interconnected Relationship

BackgroundHuman milk oligosaccharides have been shown to relate to the infant gut microbiome. However, the impact of other human milk components on infant gut bacterial colonization remains unexplored. ObjectivesOur cross-sectional analysis aimed to investigate associations between human milk components (energy, macronutrients, free amino acids, inflammatory markers, and hormones) and infant gut microbiome diversity and composition (phylum, family, and genus) at 6 mo of age. MethodsHuman milk and infant stool samples were collected at 6 mo postpartum. The infant gut microbiome was profiled using 16S rRNA sequencing. Linear regression models were performed to examine associations, adjusting for pregravid BMI (kg/m2), delivery mode, duration of human milk feeding, and infant sex, with q < 0.2 considered significant. ResultsThis analysis included a total of 54 mothers (100% exclusively feeding human milk) and infants (n = 28 male; 51.9%). Total energy in human milk showed a negative association with α-diversity measures (Chao1 and Shannon). Interleukin (IL)-8 in human milk was positively associated with Chao1 and observed operational taxonomic units. At the family level, human milk glutamine and serine levels showed a negative association with the abundance of Veillonellaceae, whereas isoleucine showed a positive association with Bacteroidaceae. Human milk IL-8 and IL-6 concentrations were positively associated with Bacteroidaceae abundance. IL-8 also had a positive relationship with Bifidobacteriaceae, whereas it had a negative relationship with Streptococcacea and Clostridiaceae. Human milk IL-8 was positively associated with the phylum Bacteroidetes, and negatively associated with Proteobacteria. At the genus level, human milk IL-8 exhibited a positive relationship with Bacteroides, whereas human milk isoleucine had a negative relationship with Bacteroides and Ruminococcus. Pregravid BMI and sex effects were observed. ConclusionsIL-8 in human milk could potentially prepare the infant’s immune system to respond effectively to various microorganisms, potentially promoting the growth of beneficial gut bacteria and protecting against pathogens.

No strong evidence of the protein leverage hypothesis in pregnant women with obesity and their infants.

The goal of this study was to investigate the role of dietary protein on macronutrient and energy intake, maternal adiposity during pregnancy, and infant adiposity at birth. In 41 women with obesity, early-pregnancy (13-16 weeks) protein intake was assessed with food photography and expressed as a ratio of Estimated Average Requirements (EAR) in pregnancy for protein (0.88 g/kg/d), herein "protein balance." Energy intake was measured by the intake-balance method, gestational weight gain as grams per week, and fat mass by a three-compartment model. Spearman correlations and linear models were computed using R version 4.1.1 (p < 0.05 considered significant). Women had a mean (SD) age of 27.5 (4.8) years and a pregravid BMI of 34.4 (2.9), kg/m2 , and the majority were non-White (n = 23, 56.1%). Protein balance in early pregnancy was not significantly associated with energy intake across mid and mid/late pregnancy (β = 328.7, p = 0.30 and β = 286.2, p = 0.26, respectively) or gestational weight gain (β = 117.0, p = 0.41). Protein balance was inversely associated with fat mass in early, mid, and late pregnancy (β = -10.6, p = 0.01, β = -10.4, p = 0.03, β = -10.3, p = 0.03, respectively). Protein balance did not predict infant adiposity at birth (p > 0.05). Low protein intake may have been present before pregnancy, explaining early relationships with adiposity in this cohort. The protein leverage hypothesis is likely not implicated in the intergenerational transmission of obesity.

Transient elastography and controlled attenuation parameter to evaluate hepatic steatosis and liver stiffness in postpartum patients

Introduction Nonalcoholic fatty liver disease (NAFLD) affects 30% of adults in the United States. Transient elastography (TE) (Fibroscan, Echosens, Paris, France) with controlled attenuation parameter (CAP) is a noninvasive way to evaluate liver steatosis and liver stiffness. The primary objective of this study was to assess prevalence of elevated liver stiffness and steatosis immediately postpartum. Furthermore, we sought to evaluate whether there were differences in rates of metabolic disorders of pregnancy (gestational diabetes mellitus (GDM), gestational hypertension, and preeclampsia) and pre-pregnancy conditions (type 2 diabetes mellitus (DM), chronic hypertension, and obesity) in those with elevated postpartum liver steatosis/liver stiffness. Methods IRB approved prospective cross-sectional study in which TE and liver function tests were performed 1–2 days postpartum. CAP ≥300 dB/m was classified as significant steatosis. Increased liver stiffness was defined as ≥7 kPa. Prevalence was determined by proportion of individuals undergoing TE/CAP who met criteria. Chi-square analysis was used to compare differences between groups. Results Eighty-nine patients were included: 20 (22%) had GDM, 13 (15%) had gestational hypertension, and 15 (17%) had preeclampsia. Women with kPa ≥7 were more likely to have ALT ≥25, type 2 diabetes, and preeclampsia (p < .05). Pre-gravid BMI, BMI at delivery, and GDM were not associated with increased kPa. Pregravid BMI ≥25 and chronic hypertension were associated with CAP ≥ 300 dB/m (p < .05). GDM, preeclampsia, and gestational hypertension were not associated with CAP ≥300 dB/m. Conclusions Patients with preeclampsia, type 2 diabetes, and elevated ALT were more likely to have elevated postpartum liver stiffness. Pregravid BMI ≥25 and ≥30 were associated with increased liver steatosis, although did not impact liver stiffness. GDM was not associated with increased liver stiffness or steatosis. Consideration should be made for screening pregnant patients with preeclampsia, type 2 DM and overweight or obese BMI for liver disease in the postpartum period with potential for lifestyle intervention.

Association between microbial composition, diversity, and function of the maternal gastrointestinal microbiome with impaired glucose tolerance on the glucose challenge test.

Over the last two decades, the incidence of gestational diabetes (GDM) has almost doubled resulting in almost 9% of pregnant women diagnosed with GDM. Occurring more frequently than GDM is impaired glucose tolerance (IGT), also known as pre-diabetes, but it has been understudied during pregnancy resulting in a lack of clinical recommendations of maternal and fetal surveillance. The purpose of this retrospective, cross-sectional study was to examine the association between microbial diversity and function of the maternal microbiome with IGT while adjusting for confounding variables. We hypothesized that reduced maternal microbial diversity and increased gene abundance for insulin resistance function will be associated with IGT as defined by a value greater than 140 mg/dL on the glucose challenge test. In the examination of microbial composition between women with IGT and those with normal glucose tolerance (NGT), we found five taxa which were significantly different. Taxa higher in participants with impaired glucose tolerance were Ruminococcacea (p = 0.01), Schaalia turicensis (p<0.05), Oscillibacter (p = 0.03), Oscillospiraceae (p = 0.02), and Methanobrevibacter smithii (p = 0.04). When we further compare participants who have IGT by their pre-gravid BMI, five taxa are significantly different between the BMI groups, Enterobacteriaceae, Dialister micraerophilus, Campylobacter ureolyticus, Proteobacteria, Streptococcus Unclassified (species). All four metrics including the Shannon (p<0.00), Simpson (p<0.00), Inverse Simpson (p = 0.04), and Chao1 (p = 0.04), showed a significant difference in alpha diversity with increased values in the impaired glucose tolerance group. Our study highlights the important gastrointestinal microbiome changes in women with IGT during pregnancy. Understanding the role of the microbiome in regulating glucose tolerance during pregnancy helps clinicians and researchers to understand the importance of IGT as a marker for adverse maternal and neonatal outcomes.

Metagenomic characterization of the maternal prenatal gastrointestinal microbiome by pregravid BMI.

The incidence of women entering into pregnancy with BMI indicating overweight or obesity is rising with concurrent increases in adverse complications such as gestational diabetes. Although several studies have examined the compositional changes to the microbiome across BMI classifications, there has been no investigation regarding changes in microbial function during pregnancy. A total of 105 gastrointestinal microbiome biospecimens were used in this analysis. Biospecimens were sequenced by using the Illumina NovaSeq 6000 shotgun metagenomics platform. Findingsindicatean enrichment in microbiota from the phylum Firmicutes across all pregravid BMI groups with a decrease in α diversity in groups with BMI indicating obesity or overweight compared with a group with BMI indicating normal weight (p=0.02). More specifically, women with BMI indicating obesity or overweight had enrichment in Bifidobacterium bifidum and B. adolescentis. Women with BMI > 25 kg/m2 had a higher abundance of microbiota that support biotin synthesis and regulate epithelial cells in the lower gastrointestinal tract. These epithelial cells are responsible for host adaptability to dietary lipid variation and caloric absorption. Our analysis suggests that there are differences in microbial composition and function between BMI groups. Future research should consider how these changes contribute to specific clinical outcomes during pregnancy.

Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England

BackgroundPolycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying results, depending on patient population, diagnostic criteria for PCOS and covariates accounted for in their analyses. We aimed to assess the risk of obstetric outcomes among a population-based representative cohort of women with PCOS compared to an age-matched cohort of women without PCOS.MethodsA retrospective cohort study was conducted of pregnancies of women in England aged 15–49 years identified from the Clinical Practice Research Datalink (CPRD) GOLD pregnancy register and linked Hospital Episodes Statistic (HES) data between March 1997 and March 2020. Pregnancies from the register that had a linked HES delivery record were included. Linked CPRD primary care data was used to ascertain maternal PCOS exposure prior to pregnancy. To improve detection of PCOS, in addition to PCOS diagnostic codes, codes for (1) polycystic ovaries or (2) hyperandrogenism and anovulation together were also considered. Sensitivity analysis was limited to only pregnant women with a diagnostic code for PCOS.Primary outcomes ascertained from linked HES data were (1) preterm delivery (gestation < 37 weeks), (2) mode of delivery, (3) high (> 4000 g) or low birthweight (< 2500 g) and (4) stillbirth. Secondary outcomes were (1) very preterm delivery (< 32 weeks), (2) extremely preterm delivery (< 28 weeks), (3) small and (4) large for gestational age.Conditional logistic regression models were performed adjusting for age, ethnicity, deprivation, dysglycaemia, hypertension, thyroid disorders, number of babies born at index pregnancy, and pre-gravid BMI. Multiple imputation was performed for missing outcome data.Results27,586 deliveries with maternal PCOS were matched for age (± 1 year) to 110,344 deliveries without PCOS. In the fully adjusted models, maternal PCOS was associated with an increased risk of (1) preterm birth [aOR: 1.11 (95% CI 1.06–1.17)], and (2) emergency caesarean, elective caesarean and instrumental vaginal compared to spontaneous delivery [aOR: 1.10 (1.05–1.15), 1.07 (1.03–1.12) and 1.04 (1.00–1.09), respectively]. There was absence of association with low birthweight, high birthweight and stillbirth. In the sensitivity analysis, the association with preterm birth [aOR: 1.31 (95% CI 1.13–1.52)], emergency caesarean [aOR: 1.15 (95% CI 1.02–1.30)], and elective caesarean [aOR: 1.03 (95% CI 1.02–1.03)] remained.While there was no significant association with any of the secondary outcomes in the primary analysis, in the sensitivity analysis maternal PCOS was associated with increased risk of extremely preterm delivery [aOR: 1.86 (95% CI 1.31–2.65)], and lower risk of small for gestational age babies [aOR: 0.74 (95% CI 0.59–0.94)].ConclusionsMaternal PCOS was associated with increased risk of preterm and caesarean delivery. Association with low birthweight may be largely mediated by lower gestational age at birth.

Gestational Diabetes Mellitus pregnancy by pregnancy: early, late and nonrecurrent GDM

AimsTo assess the GDM recurrence rate in a cohort of pregnant women with prior GDM, to compare two consecutive pregnancies complicated by GDM, to compare women with nonrecurrent and recurrent GDM and to stratify the latter in women with early and late recurrent GDM. MethodsRetrospective study including 113 women with GDM in an index pregnancy (G1), at least a postindex pregnancy (G2) and normal glucose tolerance in between. The GDM recurrence rate was assessed, and maternal and neonatal outcomes and pancreatic beta cell function of the index pregnancy were compared with those of the postindex pregnancy (G1 vs. G2). Women with nonrecurrent GDM were compared with those with recurrent GDM. ResultsThe GDM recurrence rate was 83.2% and the minimum prevalence of early recurrent GDM was 43,4%. The pregravid BMI of women with recurrent GDM increased between the two pregnancies (27.3 ± 5.98 vs. 28.1 ± 6.19 kg/m2, p < 0.05). Women with recurrent GDM had a higher prepregnancy BMI than those with nonrecurrent GDM either at the index (27.3 ± 5.98 vs. 23.1 ± 4.78 kg/m2, p < 0.05) or the postindex pregnancy (27 ± 6vs.24 ± 4,4 kg/m2, p < 0.05). ConclusionsGDM shows a high recurrence rate in our cohort of slightly overweight women, with an early GDM minimum prevalence of 43.4%.

Associations of Metabolic and Obstetric Risk Parameters with Timing of Lactogenesis II.

Lactogenesis II is the onset of copious milk production following parturition. Delayed onset of lactogenesis II (DLII) often contributes to poorer lactation performance, which may adversely affect maternal and child health. The present study aims to identify the metabolic and obstetric risk factors for DLII in a secondary analysis of a prospective cohort study following pregnant women through postpartum. We defined the onset of lactogenesis II as delayed if it occurred ≥72 h postpartum. Multiple logistic regression analyses were conducted to evaluate the associations of metabolic and obstetric variables with DLII. Median onset of lactogenesis II was 72.4 h (IQR 60.4–91.6) postpartum, and 55.4% (98 of 177) of women experienced DLII. Time to first breast contact ≥ 2 h postpartum compared to ≤1 h postpartum was associated with DLII (OR 2.71 95% CI 1.12–6.53) with adjustment for age, race, pregravid BMI, primiparity, and mode of delivery, while metabolic variables were not significantly associated with DLII. In this comprehensive examination of potential metabolic and obstetric parameters, earlier timing of putting the infant to the breast remained significantly associated with earlier onset of milk coming in after consideration of the other potential risk factors. Obstetrical practices, including putting the baby to the breast later, may have an important impact on the timing of lactation, and interventions are needed to address this concern.

The Influence of Maternal Obesity on Cell-Free Fetal DNA and Blood Pressure Regulation in Pregnancies with Hypertensive Disorders.

Background and Objectives: obesity and blood pressure disorders are one of the main risk factors for antenatal, intra, postpartum, and neonatal complications. In preeclampsia (PE), the placental hypoxia leads to vascular endothelium dysfunction, cell necrosis, and apoptosis. This condition is associated with the release of free fetal DNA (cffDNA) circulating in plasma. The disturbance of the efficiency of vasodilatation and blood pressure regulation in PE can be confirmed by analyzing the apelin, salusin, and prosalusin. This study aimed to assess the influence of obesity on cffDNA, and the effectiveness of maintaining normal blood pressure in patients with preeclampsia and gestational hypertension. Material and Methods: the research material was blood serum and oral mucosa swabs, obtained from 168 patients. Pregnant women were divided into the following: a control group (C)—67 women; a gestational hypertension group (GH)—35 patients; a preeclampsia with obesity group (PE + O) (pre-gravid BMI > 30)—23 patients. The rest were lean preeclamptic women (PE)—66 patients—(pre-gravid BMI < 25 in 43 women). Results: the cffDNA was observed in 1.50% of women in the C group, in 2.45% in the GH group, but in 18.18% of lean patients with preeclampsia. The cffDNA was detected in 58% of obese pregnant women with PE. The greater the placental hypoxia was in preeclampsia, the less efficient the hypotensive mechanisms, according to an analysis of the studied adipokines. The prosalusin concentration was significantly lower in the PE group with cffDNA than in the PE group without it (p = 0.008). Apelin was higher in the PE group with cffDNA (p = 0.006) compared to other groups. The same results were also observed in the subgroup with obesity. Conclusion: in preeclamptic women, obesity seems to act as an additive factor of placental damage by means of the dysregulation of hypotensive mechanisms.

560 Postpartum transient elastography in patients with metabolic disorders of pregnancy

Nonalcoholic fatty liver disease (NAFLD) affects 30% of the U.S. and is a risk factor for cirrhosis, liver cancer, and is the leading cause for liver transplant among women. Physiologic estrogen fluctuations and rapid weight change in pregnancy may play important roles in NAFLD. Data regarding NAFLD in pregnancy, and its association with metabolic disorders in pregnancy, is limited. Transient elastography (TE)(Fibroscan) with continued attenuation parameter (CAP) is a noninvasive way to diagnose steatosis and liver stiffness/fibrosis. IRB approved prospective study in which TE and liver function tests were performed 1-2 days postpartum. CAP ≥300 was classified as significant steatosis. Elevated liver stiffness/fibrosis was defined as ≥7 kilopascals(KPA). Chi-square analysis was used to compare differences between groups. Univariate and bivariate logistic regression was used to determine significant predictors of elevated CAP and KPA. 91 patients were included: 20(22%) had gestational diabetes (GDM), 13(14%) had gestational hypertension (gHTN), and 15(17%) had preeclampsia (PEC). Women with these metabolic disorders of pregnancy were more likely to be Black, and undergo C-section, but had lower median weight gain (Table 1). Women with KPA≥7 were more likely to have ALT≥25, Type 2 diabetes, and PEC(p<0.05)(Table 2). Pre- and post-gravid BMI, and GDM were not associated with increased KPA. Overweight pregravid BMI, and chronic hypertension were associated with CAP≥300(p<0.05). GDM, PEC, and gHTN were not associated with CAP≥300. In logistic regression analysis, PEC(OR 4.32,p=0.033) and ALT>25(OR of 5.59,p=0.007) were associated with KPA≥7 independent of BMI. Women with preeclampsia and elevated ALT were more likely to have elevated postpartum liver stiffness. Pregravid BMI≥25 and ≥30 were associated with increased liver steatosis, although did not appear to impact liver stiffness. Consideration should be made for screening women with PEC and obesity for liver disease during pregnancy with potential for lifestyle intervention. Implementation of TE postpartum is feasible.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

509 Is identifying as black enough to increase your risk of unplanned cesarean birth?

Black women are at increased risk of cesarean delivery (CD), though why is unknown. Unplanned CD is associated with increased maternal morbidity and mortality. We aimed to investigate whether race and other maternal demographic characteristics were associated with increased risk of unplanned CD at two academic hospitals. We conducted a retrospective cohort study of births > 34 weeks GA between 2017 and 2019, at two academic centers with a shared residency. Our primary outcome was CD after a trial of labor (unplanned CD). Multiple gestations, VBAC, elective repeat or primary CD, and contraindications for vaginal delivery were excluded. Median income by zip code was obtained from 2018 census data. Self-identified race, ethnicity & marital status, as well as age, parity, pregravid BMI, CD indication, & mode of delivery were extracted from the electronic medical record. Odds of unplanned CD were estimated by multivariate logistic regression. 18,946 deliveries were included in the analysis (10,616 from Hospital A and 8,339 from Hospital B). The rate of CD was 14.8% overall and 21.3% in nulliparous patients. After adjustment for age, BMI, and parity, women of Black and Asian races had significantly increased odds of unplanned CD; 1.69 (95% CI: 1.45,1.96) and 1.23 (1.08, 1.40), respectively. Adjusted OR for Hispanic women was 1.09 (0.89, 1.34). At Hospital A, those who identified as single compared to married had an aOR of 1.27, (1.09,1.47) and those in the lowest income quartile had an aOR of 1.26 (1.04, 1.52). (Table) Rates of unplanned CD were significantly higher in Black compared to White women at 2 large teaching hospitals, even after adjustment for age, BMI, parity, and zip code income strata, while Hispanic women compared to White women had no increased odds of unplanned CD. The magnitude of increased odds of CD for Black women is much higher than any other predictor or socioeconomic status. Future work is urgently needed to better understand differences in provider care or patient attributes that may contribute to these findings.

Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI.

Given the adverse effects of either polycystic ovary syndrome (PCOS) or overweight/obesity, one could speculate that patients with both would fare worse than others. We sought to evaluate the relationship between pregravid BMI and pregnancy complications in PCOS patients conceived by assisted reproductive techniques (ART). Maternal and fetal/neonatal outcomes of singleton pregnancies after assisted reproduction in women with and without PCOS were compared by pregravid body mass index (BMI, <24.9 vs.≥25kg/cm2). The study population comprised 185 with a BMI <24.9kg/cm2 including 39 (21%) with PCOS and 146 (79%) without. We also included 84 patients with BMI≥25kg/cm2, involving 34 (40.5%) with PCOS and 50 (59.5%) without. PCOS (total 73 patients) was significantly more common among overweight/obese patients, OR 2.5 (95% CI 1.4, 4.4). Neonates >4,000g were born only to the overweight/obese mothers in the PCOS group. A higher incidence of gestational diabetes, chronic hypertension, and gestational hypertension was related to pregravid overweight/obesity rather than PCOS. In this specific subgroup of patients conceived after assisted reproduction, pregravid BMI>25kg/cm2 rather than PCOS itself appears to be associated with GDM and hypertensive disorders.

Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study.

To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs. Prospective observational cohort study. Single tertiary multidisciplinary antenatal clinic in Malaysia. A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI≥27.5kg/m2 ), and 268 who were not obese with NGT. Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records. Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT)>90th centile. Fasting Tg>95th centile (3.6mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95%CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95%CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23kg/m2 and 61% had a pre-gravid BMI of ≤25kg/m2 , yet a GWG of >10kg was associated with a 4.25-fold risk (95%CI 1.71-10.53) of BWR>90th centile. Maternal lipaemia and GWG at a low threshold (>10kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy. Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.

1435-P: Impaired Early-Phase Suppression of Glucagon Secretion after Glucose Load Associated with Insulin Need during Pregnancy in Gestational Diabetes

Aims: The prevalence of gestational diabetes mellitus (GDM) has recently increased all over the world. It is hard to predict insulin need during pregnancy even if the insulin secretory capacity is evaluated when studying 75-g OGTT to screen for GDM. The role of glucagon abnormality has remarked in pathogenesis of type 2 diabetes, however, still unknown in GDM. This study was aimed to evaluate glucagon responses in GDM and to investigate whether measurement of glucagon is useful to anticipate insulin need during pregnancy. Methods: Forty-nine women diagnosed with GDM based on IADPSG criteria were enrolled into the study and re-studied OGTT during mid-gestation to evaluate glucagon responses. Plasma glucagon levels were measured before and 30, 60, 120 min after glucose load using a sandwich ELISA kit. Insulin treatment was initiated when either a fasting glucose &amp;gt;95 mg/dL or postprandial 2-h glucose &amp;gt;120 mg/dL continues for more than a week after starting diet therapy. Results: Of 49 patients, fifteen were required insulin (defined as GDM/Insulin) and 34 could be treated with diet therapy alone until delivery (defined as GDM/Diet). GDM/Insulin was started insulin treatment at 29.6±3.6 weeks of gestation and the maximum insulin dose was 39.0±24.8 units/day. There were no significant differences in maternal age, pre-gravid BMI and insulin secretory responses during OGTT between the groups. Although fasting glucagon levels were not different between the groups, paradoxical increases in early-phase glucagon secretion after glucose load were observed in GDM/Insulin but not in GDM/Diet. The changes in glucagon levels (pg/mL) from 0 min to 30 min were significantly different between the groups (1.3±8.1 in GDM/Insulin vs. -4.2±4.0 in GDM/Diet, p&amp;lt;0.01), and the ROC analysis of the value to predict insulin need was -2.01 pg/mL. Conclusions: Impaired early-phase glucagon suppression might be useful to predict for insulin need during pregnancy in GDM. Disclosure I. Horie: None. A. Haraguchi: None. N. Abiru: None. A. Kawakami: None.

Gestational diabetes mellitus in underweight women

Objective: To compare outcomes of pregnancies complicated by gestational diabetes mellitus (GDM) in underweight women with those of normal pregravid BMI.Methods: We used a population-based dataset to identify singleton pregnancies complicated by GDM in underweight and normal weight women.Results: Among women with GDM, we identified 301 and 6494 women with pregravid underweight and normal BMI. Underweight women were younger, more often nulliparous, and had lower birth weight (p < .05) and lower incidence of birth weight > 4000 g (OR 0.3, 95% CI 0.1, 0.6) as compared to normal weight GDM women.Conclusions: It appears that pregravid maternal weight rather than GDM might be responsible for larger babies. A dose-response relationship should be established, however.

The influence of maternal obesity on macrophage subsets in the human decidua

Obesity is seen as a low grade inflammatory state, and is associated with adverse pregnancy outcomes. Disturbed macrophage characteristics might be essential in obesity associated pregnancy pathology via effects on the regulation of angiogenesis and placental development. This study aims to address the effects of maternal obesity on macrophage subsets in the decidua of women with term uncomplicated pregnancies. Macrophages were isolated from the decidua basalis and decidua parietalis of women with pre-gravid BMI < 25 (control) and BMI > 30 (obese). Macrophages were characterized and quantified using multi-color flow cytometry. Placentas of 10 obese and 10 control women after an uncomplicated term pregnancy were included. The decidua parietalis, but not decidua basalis, showed significantly lower levels of M1-type (HLA-DR+, CD163−) macrophages (p < 0.05) in obese women (4,3% of total macrophages) compared to control women (5,3% of total macrophages). The lower levels of M1 macrophages, considered to be pro-inflammatory, might indicate a mechanism to compensate for the pro-inflammatory environment in obese women to ensure healthy pregnancy outcomes.

Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study

BackgroundGrowing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC).MethodsTwo hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs).ResultsAmong 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24–22.15)], preeclampsia [aOR:7.78 (1.62–37.47)], APH [aOR:3.46 (1.28–9.33)], emergency CS [aOR:2.64 (1.43–4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51–10.10)], LBW [aOR:3.11 (1.04–9.30)] and NICU admission [aOR:4.36 (1.82–10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50–16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31–12.89)], emergency CS [aOR: 2.01 (1.09–3.73] and LGA [aOR: 5.20 (1.07–25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02–11.68), preeclampsia 5.29 (1.03–27.09), and NICU admission [aOR: 2.53 (1.05–6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group.ConclusionThe findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes.

The effect of interaction between parity, gestational diabetes, and pregravid obesity on the incidence of preeclampsia

Objective: To examine the effect of parity, prepregnancy obesity and gestational diabetes on the incidence of preeclampsia in singleton pregnancies using a population-based dataset.Methods: We used the national perinatal information system (NPIS) to identify singleton pregnancies complicated by preeclampsia and analyzed dichotomous-independent variables: being obese or normal weight before pregnancy, being primiparous or multiparous, and being without gestational diabetes mellitus (GDM), with GDMA1, or GDMA2.Results: We found a significantly higher incidence of pregravid obesity among primiparas with preeclampsia (OR 1.6, 95% CI 1.55, 1.66). The data indicate that multiparas had always a significantly lower incidence of preeclampsia, regardless if the women had GDMA1, GDMA2 or had no GDM, and regardless of being of normal weight or obese before pregnancy. The data indicate that the incidence of preeclampsia was not influenced by GDM status, irrespective of parity pregravid BMI category.Conclusions: Our data indicate that GDM is not significantly associated with the development of preeclampsia.

Influence of distribution of mother’s abdominal body fat on first trimester fetal growth

Objective: Fetal growth in the first trimester is estimated by measuring the crown to rump length of the fetus (CRL). There are no data on the relation between fetal growth and fat distribution in pregnant women. The objective was to investigate the influence of fat distribution in pregnant women on fetal growth in the first trimester of pregnancy.Methods: This was a controlled observation using a random sampling method. Newly registered pregnant women were included in the sample during a 12–18-month period. The study included 400 pregnant women from Bjelovarsko-bilogorska County, Croatia. Participants were divided into three groups according to their pregravid BMI values, normal weight (n = 254), overweight (n = 103), and obese (n = 43). In the 12th week of pregnancy, the CRL was measured by transvaginal ultrasound. The subcutaneous and preperitoneal fat was measured by transabdominal ultrasound, using the Suzuki method. The correlation was tested by the Pearson’s coefficient, and a linear regression analysis was performed on the variables with good correlation.Results: In normal weight pregnant women, there is no correlation between the adipose tissue and fetal length, but there is a significant correlation between overweight and obese ones.Conclusion: The distribution of adipose tissue in obese and overweight pregnant women is associated with fetal length in the first trimester of pregnancy, with a stronger correlation between visceral fat and fetal length. The influence of this correlation on the overall fetal growth should be investigated by longitudinal monitoring of these variables during the entire pregnancy.

Effects of Weight Gain on Delivery Outcomes in an Obese Pregnant Population [17D

INTRODUCTION: The 2009 Institute of Medicine guidelines recommend 11-20 pounds weight gain for all pregnant women with a BMI ≥30. This study examines the effect of weight gain/loss on delivery outcomes in relation to class of obesity. METHODS: A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with pre-gravid BMI ≥30 was reviewed. Eligible women were non-smokers with a singleton pregnancy initiating care prior to 20 weeks. Multinomial logistic regression analysis compared gestational weight change to primary outcome of birth-weight percentile and secondary outcome of delivery type. RESULTS: Inclusion criteria were met by 889 women, with 485 in Class 1 (BMI 30-34.9), 218 in Class 2 (BMI 35-39.9), and 186 in Class 3 (BMI ≥40). Class 1 patients that lost weight were more likely to have a small-for-gestational-age (SGA) infant (P=.040) compared to Class 1 patients who had recommended weight gain. Class 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below recommendations. Class 2 patients that gained above recommendations were more likely to have a C-section during labor (P&lt;.001) while Class 3 patients that gained above recommendations were more likely to have a scheduled C-section (P=.010). CONCLUSION: Class 2 and Class 3 mothers may benefit from less weight gain than current recommendations without increasing their risk of SGA infants. Further research is needed to ascertain if weight gain recommendations should be stratified based on obesity class.