Pregnancy Program Research Articles

Impact of an mHealth intervention on parents' emotional health and on the neurodevelopment of high-risk infants.

We assess the prenatal and postnatal effect of the High-Risk Pregnancy and Baby Parenting programme, which is complemented with two mHealth (app-based) resources. The GLM Repeated Measures Model technique was used to explore differences in the emotional health of the participants and in their infants' neurodevelopment, comparing programme versus usual care groups, composed of 150 and 195 participants, respectively. The mothers presented lower levels of depression (mean difference 1.74, p = 0.04, 95% CI 0.07, 3.40) and higher levels of resilience (mean difference 4.09, p = 0.004, 95% CI 1.40, 6.78). For the fathers, positive effects on resilience were recorded (p < 0.001). A positive treatment effect was perceived in the infants' cognitive (p = 0.014), language (p < 0.001) and motor (p = 0.006) development. These findings suggest application of the programme can benefit maternal emotional health and infant neurodevelopment. M-Health technology could make this programme more accessible.

The web-based Pleasure&Pregnancy programme in the treatment of unexplained infertility: a randomized controlled trial.

The web-based Pleasure&Pregnancy programme in the treatment of unexplained infertility: a randomized controlled trial.

Enfermedad microvascular coronaria en gestante con antecedente de síndrome antifosfolípidos

Objective: to report the case of a pregnant woman with antiphospholipid syndrome history, in whom coronary microvascular disease was documented. Antenatal medical treatment improved prognosis and maternal and perinatal outcomes. Case: multigravida woman, 29.6 weeks pregnant, diagnosed with acute coronary syndrome, referred from a first level hospital. Diagnostic workup revealed microvascular disease. After receiving adequate management, she was discharged from hospital and included in the high-risk pregnancy program. Results: the diagnosis was made based on echocardiography, electrocardiography, troponin levels and cardiac catheterization. Anti-ischemic therapy was indicated considering the risk-benefit trade-off; management with aspirin was continued and the baby was born healthy. Conclusions: coronary microvascular disease should be considered, as a differential diagnosis in a pregnant woman with chest pain and history of antiphospholipid syndrome. Patients benefit from receiving antiplatelet and anticoagulant therapy soon after the diagnosis is made. Studies are required to evaluate the safest and most effective management of this condition.

Embryonic, Fetal, and Neonatal Complications in Infants of Diabetic Mothers: Insights from the Cincinnati Diabetes in Pregnancy Program Project Grant.

This study aimed to review how the Cincinnati Diabetes in Pregnancy Program Project Grant (PPG) contributed to the understanding and treatment of neonatal complications in infants of diabetic mothers (IDMs). This is a retrospective review of all PPG work on glycemic control at different pregnancy time points and its association with embryonic, fetal, and neonatal complications, such as congenital malformations (CMs), intrauterine growth restriction, macrosomia, hypoglycemia, respiratory distress syndrome (RDS), asphyxia, and polycythemia. We found that maternal vasculopathy and poor glycemic control during embryogenesis, but not frequency of maternal hypoglycemic episodes or insulin therapy, are independent risk factors for major CMs. A suggestive association of major CMs with maternal Magnesium deficiency was also observed. Poor glycemic control during late embryogenesis and early fetal development was associated with an increased risk of minor CMs. We described a biphasic pattern of fetal growth whereby early growth delay was followed by enhanced fetal growth associated with neonatal macrosomia. Macrosomia was associated with poorer glycemic control in the third trimester and an increased risk of birth trauma. Macrosomia was also correlated with animal-origin insulin concentrations in cord blood, demonstrating that insulin bound to antibodies can cross the placenta and may affect the fetus. We also showed that neonatal hypoglycemia was significantly associated with third-trimester glycemic control, in addition to hyperglycemia occurring during labor. With modern management and adequate prenatal care, IDMs are no longer at increased risk for RDS. Perinatal asphyxia was associated with increased proteinuria appearing in pregnancy, maternal hyperglycemia before delivery, and prematurity. Polycythemia in IDMs is prevalent and correlates with proxy measurements of fetal hypoxemia (nucleated red blood cells at delivery) and poorer glycemic control in late pregnancy. The PPG in its various phases revealed the important role of glycemic control at nearly every stage of pregnancy including labor. KEY POINTS: · Poor glycemic control during embryogenesis is a major risk factor for CMs.. · Magnesium deficiency might contribute to major malformations.. · Macrosomia is associated with poor glycemic control in the third trimester.. · Strict glycemic control reduces fetal and neonatal morbidity in pregnancies with insulin-dependent diabetes mellitus..

Pengaruh Tidak Langsung Penggunaan Alat Kontrasepsi terhadap Kejadian Stunting di Desa Oetutulu, Kabupaten Rote Ndao

Stunting is a disorder of child growth and development due to chronic malnutrition and recurrent infections, characterized by a child's length or height below the standard. Indirect causes of stunting include ineffective parenting, health services, food availability, economy, parental education, clean water sources and environmental sanitation. The use of contraceptives is also one of the indirect causes of stunting. In 2023, Northwest Rote Subdistrict experienced 338 incidents of stunting and Oetutulu Village experienced 51 prevalence of stunting caused by a lack of good pregnancy planning, so that the birth distance became too close. This research is an analytic survey research using cross-sectional method. The purpose of this study was to determine the effect of contraceptive use on the incidence of stunting in Oetutulu Village, Rote Ndao Regency. The results showed that there was a significant influence between knowledge (p=0,034) and attitude (p=0,025) of couples of childbearing age on the use of contraceptives. The use of contraceptives also affects the incidence of stunting in Oetutulu Village, Rote Ndao Regency. It is expected that the community of Oetutulu Village can better plan pregnancy programs and use contraceptives as an effort to reduce the incidence of stunting.

Changes in maternal blood and placental lipidomic profile in obesity and gestational diabetes: Evidence for sexual dimorphism.

Obesity and gestational diabetes (GDM) are associated with adverse pregnancy outcomes and program the offspring for cardiometabolic disease in a sexually dimorphic manner. The placenta transfers lipids to the fetus and uses these substrates to support its own metabolism impacting the amount of substrate available to the growing fetus. We collected maternal plasma and placental villous tissue following elective cesarean section at term from women who were lean (pre-pregnancy BMI 18.5-24.9), obese (BMI>30) and type A2 GDM (matched to obese BMI) with male or female fetus (n=4 each group). Lipids were extracted and fatty acid composition of different lipid classes were analyzed by LC-MS/MS analysis. Significant changes in GDM vs obese, GDM vs lean, and obese vs lean were determined using t-test with a Tukey correction set at p<0.05. In placental samples 436 lipids were identified, among which 85 showed significant changes. Of note only in male placentas significant decreases in C22:6 - docosahexaenoic acid (DHA) in phosphatidylcholine (PC) and triglyceride lipid species were seen when comparing tissue from GDM women to lean. In maternal plasma we observed no effect of obesity. GDM or fetal sex. This is the first study assessing fatty acid composition of lipids in matched maternal plasma and placental tissue from lean, obese, and GDM women stratified by fetal sex. It highlights how GDM affects distribution of fatty acids in lipid classes changes in a sexually dimorphic manner in the placenta.

Predictors for 25-hydroxyvitamin D concentration in early pregnancy

Introduction: There are very few studies of vitamin D deficiency in Indonesia. Since vitamin D deficiency is indicated by the level of 25-hydroxyvitamin D (25(OH) D) in blood, the present study aimed to analyse the predictive factors of 25(OH) D concentration in early pregnancy. Methods: The present study was a crosssectional observational study. The sample consisted of 67 pregnant women in their 1st trimester of pregnancy. Parameters assessed included levels of 25(OH)D, glucose, and haemoglobin in the blood. Demographic information such as parity, family history of diabetes mellitus (DM), exposure to cigarette smoke, physical activity level, dietary intake, and anthropometric measurements were recorded. Linear regression analysis was employed. Results: Mean concentration of 25(OH)D was 16.5 (6.6-34.1) ng/ml. Majority of the participants (77.6%) were deficient in vitamin D (25(OH)D &lt;20ng/mL); only 1.5% had normal vitamin D levels (25(OH)D &gt;30 ng/ mL). Bivariate analysis performed revealed that vitamin D intake (p=0.002) and family history of DM (p=0.043) played a significant role in determining 25(OH)D concentration. Additionally, dietary vitamin D intake, blood glucose level, exposure to cigarette smoke, and parental DM history served as predictors of 25(OH)D concentration in 54.5% of cases. Conclusion: The findings indicate that vitamin D deficiency was high in the target population. Thus, it is critical to ensure that for pregnant women to take vitamin D supplements, since nearly 80% of pregnant mothers are vit D deficient. Vitamin D supplementation can be included in national pregnancy programmes

A cost-effectiveness evaluation of a dietitian-delivered telephone coaching program during pregnancy for preventing gestational diabetes mellitus

BackgroundThis study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM.MethodsData to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses.ResultsThe costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000.ConclusionFindings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.

The Association of Family Income, Birth Length, and Energy Intake with The Incidence of Stunting in Cibungbulang Sub-District

Stunting is a developmental disorder in toddlers characterized by H/A index z-score of less than -2SD. Based on the results of SSGI 2022, the prevalence of stunting among toddlers in Bogor Regency reached 24.9 percent. This study aimed to determine the relationship between family income, birth length, and energy intake with the incidence of stunting among toddlers in Cibungbulang District. The sample was 151 toddlers aged 24 – 59 months who were selected by systematic random sampling. Intake data were collected with 24-hour food recall, stunting by measuring heights, and other data were collected by interview using questionnaires. Most of the toddlers were male (57.6%) with fathers aged &gt;35 year (58.3%) and graduated from senior high school (34,4%) and mothers aged 21 – 35 years (70.2%) with high school diploma or its equivalent (34.4%). Most of the children-under-five had families with income below the regional minimum wage (88.1%), normal birth length (80.8%), adequate and excessive energy intake (53.6%). A total of 41.7 percent of toddlers were stunted. There were significant relationships between family income (p=0.022), birth length (p=0.040), and energy intake (p=0.040) with the incidence of stunting in toddlers (p&lt;0.05). It can be concluded that family income, birth length, and energy intake are related to the incidence of stunting in toddlers aged 24 – 59 months in Cibungbulang District. Maternal nutrition intake needs to be monitored carefully during pregnancy and home food gardening program should be promoted to increase food availability and income thus ensuring optimal children development.

Prolonged detection of urine norfentanyl in individuals enrolled in a medication for opioid use disorder in pregnancy and postpartum program: a case series

ObjectivesAlthough urine drug testing can have vast legal and social ramifications, its interpretation during pregnancy and postpartum remains not well understood. Fentanyl metabolism is altered by an individual's genetics, history of opioid use, and liver function. However, little is known about the clearance of fentanyl or its primary metabolite, norfentanyl, in the peripartum period. MethodsWe describe three cases of delayed urine norfentanyl clearance in pregnant and postpartum individuals in a co-located obstetrics, postpartum and addiction medicine program. This program includes prescriptions for medication for opioid use disorder (MOUD) and weekly urine drug testing with fentanyl immunoassay with reflex confirmation testing with liquid chromatography mass spectrometry (LC-MS/MS) for positive results with a limit of detection of 2.5ng/ml. ResultsLow levels of norfentanyl (<16.3 ng/ml) were detected in urine 294 days, 126 days, and 231 days after last fentanyl use. Patient self-reported abstinence was supported by consistently negative urine fentanyl levels throughout collection period, compliant weekly urine drug tests that were otherwise only positive for buprenorphine, and negative fentanyl and norfentanyl in umbilical cord toxicology. DiscussionThe presence of norfentanyl in urine despite compliance in a MOUD program has significant consequences on the maternal-child dyad in the postpartum period. We caution the use of low levels of quantitative drug results for norfentanyl to determine an individual's abstinence, as it can lead to further discrimination against women in MOUD programs.

Using I-MAIHDA to extend understanding of engagement in early years interventions: an example using the Born in Bradford's Better Start (BiBBS) birth cohort data

BackgroundIntervention in the early years is essential for reducing health and social inequalities across the lifespan. The success of pregnancy and early years programmes depends on engagement from target parents and families, yet there is no consensus on which factors predict engagement. This could be due to differences between interventions at the local level, or due to unexplored interactions between factors in their relationships with engagement. This study highlights the value of the intersectional application of the multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) approach for adding nuance to our understanding of inequalities in engagement in interventions. MethodA context-driven, programme-specific analysis exploring factors relating to participation across the Better Start Bradford early years interventions acted as an applied example of the utility of I-MAIHDA. Two analyses were performed using data from the Born in Bradford's Better Start (BiBBS) birth cohort dataset to explore the effects of combinations of ethnicity, migrant status, spoken English ability and social support on participation in the interventions. Predicted prevalence of participation was obtained from the models. ResultsCombinations of English language ability, migrant status, social support, and ethnicity were found to be related to differential prevalence of participation in the interventions, with inequalities in participation between strata. Discriminatory accuracy of the models was low but not negligible (∼5%), suggesting some of the variation in outcomes was due to the combined effect at the strata level. ConclusionsThe I-MAIHDA approach showed promise for extending knowledge of engagement in interventions through context-driven analyses which incorporates complex relationships between multiple covariates. This approach will be of interest to anyone working to increase participation in interventions, especially in under-represented or marginalised groups.

Assessment of Severity of Long QT Syndrome Phenotype and Risk of Fetal Death.

It has been postulated that long QT syndrome (LQTS) can cause fetal loss through putative adverse effects of the channelopathy on placenta and myometrial function. The authors aimed to describe the fetal death rate in a population of pregnant women with long QT syndrome and investigate whether women with more severe phenotype had worse fetal outcomes. The authors retrospectively evaluated fetal outcomes of 64 pregnancies from 23 women with long QT syndrome followed during pregnancy in a tertiary pregnancy and heart disease program. Thirteen of 64 pregnancies (20%) resulted in a fetal loss, 12 miscarriages (19%), and 1 stillbirth (1.6%). Baseline maternal characteristics, including age and use of β-blockers, did not differ between women who experienced a fetal death or not. Maternal corrected QT interval (QTc) was significantly longer in pregnancies that resulted in fetal death compared with live births (median, 518 ms [interquartile range (IQR), 482-519 ms] versus 479 ms [IQR, 454-496 ms], P<0.001). Mothers treated with β-blockers had babies born at term with lower birth weight compared with untreated women (2973±298 g versus 3470±338 g, P=0.002). In addition, the birth weight of babies born at term to treated women with QTc >500 ms was significantly lower compared with women with QTc <500 ms (2783±283 g versus 3084±256 g, P=0.029). Women with long QT syndrome with more severe phenotypes have a higher incidence of fetal death. Maternal QTc is longer in pregnancies that result in fetal loss, and the birth weight of babies born to patients taking β-blockers with a QTc >500 ms is lower, suggesting that patients with more marked phenotype may experience worse fetal outcomes.

The Role of Family Planning (KB) Programs and Family Financial Management to Support Demographic Bonuses in West Java Province EcceS: Economics Social and Development Studies

The Role Of Family Planning (Kb) Programs And Family Financial Management To Support Demographic Bonuses In West Java Province Robert Maltus said that population growth is much faster than the growth of natural resources, and the existing population cannot be filled into a full workforce because of the limited available jobs. The government in Indonesia, especially the National Family Planning Coordinating Board (BKKBN) launched the Family Planning (KB) program to help suppress or slow down the rate of population growth, because if this is not done at the time of the Demographic Bonus, there will be a surge in the productive population which not all of them can be absorbed by the population. employment. In carrying out family planning, of course, it must be accompanied by clear financial planning, when the child is ready to go to school, the type of school chosen and to the extent that parents can afford to pay for their child's schooling. As a parent, of course, you have to plan all of this when your child is born or even when carrying out a pregnancy program. Based on the research results, it turns out that the partner support variable influences a person to participate in the program, although this variable is also very dependent on other variables, and most importantly, the desire variable is not the main key variable that determines a person's decision to join the family planning program, but the cost information variable. , education and type of family planning are the 3 key variables for someone to join the family planning program and underlie someone to make financial planning, because clear financial planning from the start of marriage really helps families to create proper education.

Recovered Parental AKI Results in Dysfunctional Pregnancy and Offspring Programming

Recovered Parental AKI Results in Dysfunctional Pregnancy and Offspring Programming

Making the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth

BackgroundIn the absence of medical necessity, opting for caesarean sections exposes mothers and neonates to increased risks of enduring long-term health problems and mortality. This ultimately results in greater economic burden when compared to the outcomes of spontaneous vaginal births. In Switzerland around 33% of all births are by caesarean section. However, the rate of caesarean sections without medical indication is still unknown. Therefore, we devise an identification strategy to differentiate caesarean sections without medical indication using routine data. In addition, we aim to categorize the influencing factors for women who undergo spontaneous vaginal births as opposed to those with caesarean sections without medical indication.MethodWe use Swiss Federal Statistics data including 98.3% of all women giving birth from 2014 to 2018. To determine non-medically indicated caesarean sections in our dataset, we base our identification strategy on diagnosis-related groups, diagnosis codes, and procedure classifications. Subsequently, we compare characteristics of women who give birth by non-medically CS and external factors such as the density of practicing midwives to women with spontaneous vaginal birth. Logistic regression analysis measures the effect of factors, such as age, insurance class, income, or density of practicing midwives on non-medically indicated caesarean sections.ResultsAround 8% of all Swiss caesarean sections have no medical indication. The regression analysis shows that higher age, supplemental insurance, higher income, and living in urban areas are associated with non-medically indicated caesarean sections, whereas a higher density of midwives decreases the likelihood of caesarean sections without medical indication.ConclusionsBy identifying non-medically indicated caesarean sections using routine data, it becomes feasible to gain insights into the characteristics of impacted mothers as well as the external factors involved. Illustrating these results, our recommendation is to revise the incentive policies directed towards healthcare professionals. Among others, future research may investigate the potential of midwife-assisted pregnancy programs on strengthening spontaneous vaginal births in absence of medical complications.

Infertile Couple and Pregnancy Outcomes for Patients Undergoing a Pregnancy Program in the Rural Area of Nagekeo District, Flores, East Nusa Tenggara

Objective: To elucidate the characteristics of infertile couples residing in the rural area of Nagekeo Regency and assess the outcomes of their participation in the local pregnancy program.&#x0D; Methods: We conducted a descriptive study at Aeramo Regional General Hospital (RGH) in Nagekeo Regency, Flores, East Nusa Tenggara (ENT), utilizing a total sampling technique from January 2020 to April 2022. A total of 56 couples participated in this study.&#x0D; Results: The analysis revealed that infertile couples at Aeramo RGH were typically aged between 23 and 35 years, with an average infertility duration exceeding 4 years. Primary infertility was the predominant condition (89.3%), with 55.4% of male partners exhibiting obesity. A significant number of male participants reported alcohol and cigarette consumption. Data were insufficient to determine the prevalence of infertility in men versus women. Notably, the outcomes of the pregnancy program in this region did not demonstrate significant improvements.&#x0D; Conclusions: This study identified potential risk factors such as smoking, alcohol consumption, and obesity that may contribute to infertility; however, it did not establish a strong correlation between these factors and infertility. Moreover, the pregnancy program's outcomes were inconclusive, likely due to limited diagnostic and treatment resources in the area.&#x0D; Keyword: infertility characteristics, pregnancy program, pregnancy outcomes.&#x0D; &#x0D; &#x0D; &#x0D; Abstrak&#x0D; Tujuan : Mendeskripsikan karakteristik pasangan infertil di Kabupaten Nagekeo serta mengetahui hasil luaran kehamilan bagi pasangan yang mengikuti program kehamilan di daerah tersebut.&#x0D; Metode : Penelitian ini merupakan penelitian deskriptif yang dilakukan di Rumah Sakit Umum Daerah (RSUD) Aeramo, Kabupaten Nagekeo, Flores, Nusa Tenggara Timur. Dengan menggunakan teknik total sampling pada periode Januari 2020 - April 2022, terdapat 56 pasangan yang bergabung dalam penelitian ini.&#x0D; Hasil : Hasil penelitian kemudian dianalisis secara univariat dan didapatkan usia pasangan infertil di Aeramo RGH adalah antara 23 - 35 tahun dengan durasi infertilitas lebih dari 4 tahun. Infertilitas primer dan obesitas pada pria mendominasi masing-masing kelompok yaitu 89,3% dan 55,4%. Mayoritas pria mengonsumsi alkohol dan rokok. Tidak ditemukan data yang cukup untuk menentukan apakah infertilitas terjadi pada pria atau wanita. Hasil dari program kehamilan yang dilakukan di daerah ini belum menunjukkan hasil yang signifikan.&#x0D; Kesimpulan : Karakteristik yang memicu faktor risiko seperti merokok, mengkonsumsi alkohol dan obesitas. Meskipun pada penelitian ini belum didapatkan korelasi yang kuat dari faktor risiko tersebut pada infertilitas. Hasil dari program kehamilan belum menunjukkan hasil yang signifikan karena modalitas diagnostik dan pengobatan yang sangat terbatas.&#x0D; Kata kunci : karakteristik infertilitas, luaran kehamilan, program hamil.

My Health My Language bridging the gap in public healthcare messaging

Abstract Issue Like many other European countries there has been a sharp increase in the number of migrants in Ireland recently. 13.9% of migrants in Ireland have poor or no English (Census 2016) and are not reached with mainstream public health messaging. Prior to the COVID-19 pandemic, most intercultural health resources were written rather than audio-visual. A clear need to reach out to these communities was identified. Project In 2021 the Health Service Executive (HSE) National Social Inclusion Office (NSIO) initiated a project with Translate Ireland (TI) to address the gap in intercultural health resources. Through consultation, priority health protection and health service areas were identified for inclusion in a suite of videos in main migrant languages. NSIO consulted with mychild.ie, National Immunisation Office, Irish College of GPs, Public Health, HSE Communications and the Sexual Health/Crisis Pregnancy Programme to ensure the scripts were aligned with HSE policy. TI identified health professionals living and working in Ireland, that were part of the migrant communities, to deliver key messages in the videos. TI worked with the presenters in wording the scripts to ensure cultural appropriateness. Results 11 primary care/maternal care videos were produced in 17 languages (187 videos), for healthcare professionals and people seeking health information. A dedicated webpage was created to ensure the videos were easily accessible and the project was named My Health My Language. The project was formally launched in June 2022 by the Minster of Health. We engaged with migrant communities, NGOs and government departments to share the multi-media video messages. By June 2023 there are 14,055 views of the videos. Lessons As smartphones are widely used by underserved groups, video messaging is very effective, for those with limited English or where English is not their first language. Short URLs on social media are very effective in providing access to videos. Key messages • My Health My Language is a health equity initiative, addressing health information needs of people who have limited English or where English is not their first language. • Culturally appropriate healthcare videos by peer healthcare professionals speaking in their own language have had significant reach, with over 14,000 views since launching in April 2022.

Pregnancy programs the brain for mothering.

Progesterone and estrogen exert separate effects on the brains of pregnant mice.

SAT132 Isolated Elevated Hemoglobin A1c At Early Diagnosis Of Gestational Diabetes Does Not Predict Need For Hypoglycemic Agents

Abstract Disclosure: E.S. Markovic: None. J. Rios: None. S. Scarpelli-Shchur: None. E. Kaplowitz: None. T.S. Strauss: None. L. Brustman: None. Introduction: ACOG recommends universal screening for gestational diabetes (GDM) at 24 - 28 weeks, as well as screening at the initiation of prenatal care for patients with risk factors. While HbA1c ≥5.7% signifies impaired glucose regulation, data is limited regarding its prognostic utility in patients with early diagnosis of GDM (&amp;lt;24 weeks). We hypothesized that HbA1c &amp;gt;5.7% at diagnosis predicts worse disease as measured by need for hypoglycemic medication. We also compared neonatal outcomes between patients HbA1c &amp;gt; and &amp;lt; 5.7%. Methods: An IRB approved retrospective cohort study from 2016 - 2021 of patients in our Diabetes in Pregnancy Program diagnosed with GDM &amp;lt;24 weeks by Carpenter-Coustan criteria or fingerstick paneling. We compared those with HbA1c &amp;gt;5.7% to those with HbA1c &amp;lt;5.7% with regard to demographics, need for hypoglycemic medication in pregnancy and neonatal outcomes including birth weight, Apgar scores, hypoglycemia, respiratory distress, jaundice, stillbirth and NICU admission. Results: 113 out of 1,520 patients had early onset GDM with HbA1c drawn at time of diagnosis. HbA1c range 4.5 - 7.5% (median 5.5%). Gestational age at diagnosis range 6.4 - 23 weeks (median 15.6 weeks). 72 (64%) had a HbA1c &amp;lt;5.7% while 41 (36%) had a HbA1c ≥5.7%. Larger BMI (p&amp;lt;0.0001), higher fasting GTT (p&amp;lt;0.0001), larger number of abnormal GTT values (p=0.009), Hispanic ethnicity (p=0.003) or Black race (p=0.004), and hyperlipidemia (p=0.016) were significantly associated with HbA1c &amp;gt;5.7%. A greater proportion of patients with HbA1c ≥5.7% required hypoglycemic medication [37 (90%) vs. 51 (71%), p= 0.032]. Patients with HbA1c &amp;gt;5.7% were 3.9 times more likely to require hypoglycemic agents compared to patients with HbA1c &amp;lt;5.7% (p=0.042). The odds of receiving medication were 8.5 times greater for each percent increase in HbA1c (p=0.004). After adjusting for confounders, HbA1c ≥5.7% at early GDM diagnosis was not significantly associated with increased likelihood of needing hypoglycemic agents (OR=3.4; p=0.304). Only fasting GTT was associated with needing hypoglycemic agents (OR=1.2; 95% CI: 1.0, 1.3; p=0.023). HbA1c &amp;gt;5.7% was associated with lower Apgar score at 1 minute (p=0.039) and earlier gestational age at delivery (p=0.009) but these were not significant after adjusting for confounders. Conclusion: The premise of our study was that HbA1c &amp;gt;5.7% in early diagnosed GDM would be associated with impaired glucose tolerance and therefore more significant disease. Counterintuitively, our data do not suggest this. An isolated HbA1c &amp;gt;5.7% was not predictive of the need for hypoglycemic agents or adverse neonatal outcomes. Future directions should include large prospective studies to clarify if HbA1c &amp;gt;5.7% is associated with more severe disease, adverse neonatal outcomes, and the development of type 2 diabetes. Presentation: Saturday, June 17, 2023

High maternal adiposity during pregnancy programs an imbalance in the lipidome and predisposes to diet-induced hepatosteatosis in the offspring.

Exposure to high maternal adiposity in utero is a significant risk factor for the later-life development of metabolic syndrome (MetS), including non-alcoholic fatty liver disease (NAFLD). We have previously shown that high pre-pregnancy adiposity programs adipose tissue dysfunction in the offspring, leading to spillover of fatty acids into the circulation, a key pathogenic event in obesity-associated MetS. Herein, we hypothesized that programming of adipose tissue dysfunction in offspring born to overweight dams increases the risk for developing NAFLD. Females heterozygous for leptin receptor deficiency (Hetdb) were used as a model of high pre-pregnancy adiposity. Female wild-type (Wt) offspring born to Hetdb pregnancies gained significantly more body fat following high-fat/fructose diet (HFFD) compared with Wt offspring born to Wt dams. HFFD increased circulating free fatty acids (FFA) in male offspring of control dams, while FFA levels were similar in HFFD-fed offspring from Wt dams and CD or HFFD-fed Wt offspring from Hetdb dams. Despite female-specific protection from diet-induced FFA spillover, both male and female offspring from Hetdb dams were more susceptible to diet-induced hepatosteatosis. Lipidomic analysis revealed that CD-offspring of overweight dams had decreased hepatic polyunsaturated FA (PUFA) levels compared with control offspring. Changes to saturated FA (SFA) and the de novo lipogenic (DNL) index were diet driven; however, there was a significant effect of the intrauterine environment on FA elongation and Δ9 desaturase activity. High maternal adiposity during pregnancy programs a susceptibility to diet-induced hepatosteatosis.