bluuebunny/crossref_metadata_2025_split huggingface dataset:
1346-P: Glyburide vs. Insulin for the Treatment of Gestational Diabetes in an Integrated Health Care System
Authors: HEDDERSON MONIQUE M. , FERRARA ASSIAMIRA , REGENSTEIN ANNE , NEUGEBAUER ROMAIN 
Published: June 2020

Almost 30% of women with gestational diabetes (GDM) fail to achieve glycemic control with lifestyle modification alone and require medication treatment. Currently, the American Diabetes Association recommends insulin as the first line medication treatment for women with GDM. However, oral agents have several advantages including ease of use and acceptance among patients. The safety and efficacy of glyburide for the treatment of GDM remains controversial. We aimed to compare the effectiveness of glyburide and insulin in improving perinatal outcomes. We used rigorous causal inference methods with time-varying exposures and machine learning to evaluate perinatal outcomes of exposure to glyburide versus insulin during pregnancy in a retrospective cohort study of 11,321 women diagnosed with GDM who required medication treatment to achieve glycemic control in Kaiser Permanente Northern California from 2007-2017. For each outcome, Inverse Probability Weighting (IPW) estimation was used to separately compare several perinatal outcomes between glyburide versus insulin initiators. This approach combined with Super Learning for propensity score estimation can account for both baseline and time-dependent confounding in per protocol analyses to evaluate the effect of continuous exposure to the same therapy. Women who used glyburide versus insulin had similar rates of macrosomia, hypoglycemia, hyperbilirubinemia, and cesarean delivery; significantly lower rates of a NICU admission (risk difference -0.03 [95%CI:-0.06;-0.002]) or respiratory distress syndrome (-0.02 [-0.04;-0.001]) and suggestive higher rates of an appropriately sized for gestational age infant (0.04 [-0.002;0.08]) after adjusting for baseline and time-varying covariates. Using data from a real-world clinical setting we find no evidence to suggest that adverse outcomes were higher among glyburide users compared with insulin users.

Disclosure
M.M. Hedderson: None. A. Ferrara: None. A. Regenstein: None. R. Neugebauer: None.

Funding
Permanente Medical Group
1348-P: Social Adaptability Index and Pregnancy Outcomes in Women with Diabetes during Pregnancy
Authors: PALATNIK ANNA , THAKKAR MADHULI Y. , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2020

Objective: The social adaptability index (SAI) is a composite indicator capturing an individual’s social adaptability within society and socioeconomic status in order to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women whose pregnancy is complicated by diabetes.
Methods: Data from the 2011-2017 National Survey of Family Growth were analyzed using cross-sectional methodology. Women with a singleton gestation age 18-44 were included. Maternal diabetes was defined as either presence of pre-gestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: education level, employment status, income, marital status and substance abuse. Higher score indicates lower risk. Multivariable logistic regression models were run to assess the association between SAI and pregnancy outcomes associated with diabetes, including cesarean delivery, macrosomia (birthweight &gt;4000g) and preterm delivery (&lt;37 weeks), stratified by maternal diabetes. All analyses were weighted.
Results: A total of 18,304 women were included in the analysis, with 1,965 (10.7%) having diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy, compared to controls (6.7±0.2 vs. 7.2±0.1, p&lt;0.001). In the univariable analysis, the SAI had a significant association with the outcomes of preterm delivery (OR=0.94, p&lt;0.001) and was not significantly associated with cesarean delivery or macrosomia. In adjusted multivariable analysis, controlling for maternal race/ethnicity, insurance status, body mass index, age and partner support of the index pregnancy, SAI remained to be independently associated with preterm delivery among women with diabetes during pregnancy (aOR=0.83, 95% CI 0.77-0.94).
Conclusion: Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm delivery.

Disclosure
A. Palatnik: None. M.Y. Thakkar: None. R.J. Walker: None. L.E. Egede: None.
1351-P: Association of Muscle/Fat Mass Ratio in the First Trimester with Gestational Diabetes Mellitus in Chinese Subjects
Authors: LI PING , LIN SHUO , FAN JIANHUI , ZENG LONGYI 
Published: June 2020

This study aims to evaluate the association of muscle/fat mass ratio in the first trimester with gestational diabetes mellitus (GDM) in Chinese subjects. A total of 3011 pregnant women were recruited from our hospital, Guangzhou, China, from Jan 2017 to Dec 2017. The muscle/fat mass ratio (&lt; 13+6 weeks’ gestation) and 75-g OGTT (24-28 weeks’ gestation) were measured in each subject. The muscle/fat mass ratio was assessed by bioelectrical impedance analysis. GDM was diagnosed according the IADPSG guideline (2010). All subjects had average age 29 years (interquartile range:27-32 years), mean pregestational body mass index 20.7±2.6kg/m2, muscle/fat mass ratio 2.64±0.65. Five hundred and forty eight subjects (17.9%) were diagnosed as GDM. The prevalence of GDM were 25.9%, 20.4%, 14.1%, and 11.3% among subjects with muscle/fat mass ratio in 1st quartile (≤2.15), 2nd quartile (2.16-2.61), 3rd quartile (2.62-3.08), and 4th quartile(≥3.09), respectively. The prevalence of GDM decreased while muscle/fat mass ratio increased. The area under ROC curve was 0.612 (0.595-0.630) for the muscle/fat mass ratio in predicting GDM (P&lt;0.0001) and the threshold of 2.59 yielded the highest combination of sensitivity (63.2%) and specificity (55.7%). This study suggested the muscle/fat mass ratio in the first trimester may be used as an index to predict GDM in Chinese subjects.

Disclosure
P. Li: None. S. Lin: None. J. Fan: None. L. Zeng: None.

Funding
Science and Technology Planning Project of Guangdong Province (2017A020215026); Medical Scientific Research Foundation of Guangdong Province (A2017314)
1356-P: Can First-Trimester Glycated Hemoglobin Predict Gestational Diabetes Diagnosis?
Authors: FARO FERNANDA , RAMALHO RODRIGO F. , PRIETO WESLEY H. , PEREIRA MARIANA , SALLES JOAO E. , ROSA PEDRO S. , TELES MILENA G. , TAVARES RUSSO PEDRO DE SÁ 
Published: June 2020

Background: diagnostic criteria for gestational diabetes mellitus (GDM) have been controversial. Although Oral Glucose Tolerant Test (OGTT) is generally proposed, it requires an extensive preparation, is uncomfortable and lacks reproducibility. In contrast, Glycated Hemoglobin test (A1C) is more convenient and accurate, however, its use for GDM diagnosis has not been recommended yet. The aim of this study was to evaluate whether a first trimester A1C predicts an abnormal second trimester OGTT.
Methods: This was an observational retrospective study that included Brazilian women screened with A1C until 14 weeks of gestation between January 2009 and March 2019. Data were collected from a laboratory center. A1C was measured by high-performance liquid chromatography. Exclusion criteria were first trimester glycemia ≥ 92 mg/dL or A1C ≥ 6.5% and use of antidiabetic drugs or insulin. Primary outcome was association between A1C value and diagnosis of GDM, according to 75g or 100g OGTT, as defined by American Diabetes Association (ADA).
Results: a total of 373 women were included, 106 were diagnosed with GDM by OGTT. General characteristics of the groups with and without GDM were, respectively: mean age 35.1 ±3.5 and 34.1 ± 3.5 years, mean Body Mass Index (BMI) 24.2 ± 4.8 and 25.4 ± 3.7 Kg/m², mean first trimester glycemia 81.8 ± 5.1 and 81.2 ± 5.2 mg/dL and mean A1C 5.1 ± 0.3 and 5.0 ± 0.3%. OGTT values in the GDM group were: fasting 80.1 ± 6.6, 1st hour 171.6 ± 25.7 and 2nd hour 152 ± 27.1. For women without GDM, the results were: fasting 78.1 ± 5.7, 1st h 143.4 ± 29.5 and 2nd h 123.1 ± 28.3. There was no significant statistical difference of A1C values between groups with or without GDM (P=0.26, Wilcoxon test).
Conclusion: A1C could not predict women who would develop GDM in this population. Ethnicity and different criteria for OGTT interpretation may have contributed for these findings. The limitations of this study were lack of data about previous history of GDM, family history of diabetes and weight gain during pregnancy.

Disclosure
F. Faro: None. R.F. Ramalho: None. W.H. Prieto: None. M. Pereira: None. J.E. Salles: Board Member; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc. P.S. Rosa: None. M.G. Teles: None. P. de Sá Tavares Russo: None.
1361-P: Rapid Development of Hypoglycemia and Hypoglycemia Unawareness in a Pregnant Patient with Cystic Fibrosis Related Diabetes (CFRD) on a Basal-Predominant Insulin Regimen
Authors: LITVIN MARINA 
Published: June 2020

Background: Patients with CF are at risk for gestational diabetes/CFRD, which is challenging to treat. Traditional insulin regiments with fixed prandial and high basal insulin increase hypoglycemia.
Case: A 23 year old woman with CF was diagnosed with gestational diabetes and started on NPH 18 units qAM/8 at HS, and Lispro 6 units TID. She had a blood glucose of 36 mg/dL in clinic, with which she was asymptomatic, suggesting hypoglycemia unawareness. NPH was discontinued and a 1:12 carb ratio was started, reducing glycemic excursions and hypoglycemia.
Discussion: Patient rapidly developed hypoglycemia on a basal-predominant regimen. By decreasing basal insulin and targeting prandial insulin coverage we more closely approximated CFRD physiology, improving glycemic excursions and hypoglycemia.
Conclusion: Due to physiology of CFRD, basal-predominant regiments may cause fasting hypoglycemia and post-prandial hyperglycemia. Providers should be aware that patients with gestational diabetes/CFRD have minimal basal insulin requirements and glycemic control should focus on flexible prandial coverage of their high in carbohydrates diet.

Disclosure
M. Litvin: None.
137-OR: Trends in Lipid Levels Relative to Lipid-Lowering Drug Use among Danish Type 2 Diabetes Subjects
Authors: AMADID HANAN , DUNBAR MARIA BEKKER-NIELSEN , RØNN PERNILLE F. , KNUDSEN JAKOB S. , CARSTENSEN BENDIX , PERSSON FREDERIK , JØRGENSEN MARIT E. 
Published: June 2020

Background: Lipid-lowering treatment is crucial in preventing cardiovascular disease in type 2 diabetes subjects. It is unknown how well treatment guidelines translate into clinical practice. We examined measured lipid levels in relation to use of lipid-lowering drugs among type 2 diabetes subjects in Denmark from 2010 to 2017.
Methods: The study population consisted of 404,389 subjects with type 2 diabetes living in Denmark between 1996 and 2017 identified using the Danish Diabetes Register. Redemptions of prescribed lipid-lowering drugs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels was sourced from the National Laboratory Database containing detailed information on laboratory measurements at major clinical laboratories since 2010. A drug-exposure function was developed and applied to examine follow-up of lipid-lowering drug coverage at any given time based on the redeemed amount and dose of lipid-lowering drugs. Annual mean lipid levels were obtained by calculating the mean lipid measurement value per subject, per calendar year, and per lipid type. Proportions of subjects within LDL thresholds were calculated according to thresholds defined by 2019 European Society of Cardiology dyslipidemia guidelines.
Results: In total, 64% of subjects redeemed at least two prescriptions of lipid-lowering drugs during the study period. A decline in levels of total-cholesterol and LDL was observed in the years from 2010 to 2017 in users and non-users of lipid-lowering drugs. Annual mean LDL levels were lower among lipid-lowering drug users compared with non-users (in 2017: 1.84 and 2.57 mmol/L, respectively). A greater fraction of lipid-lowering drug users achieved the LDL goal of &lt;1.8 mmol/L compared with non-lipid-lowering drug users (in 2017: 51.7% and 19%, respectively).
Conclusions: Lipid-lowering drug use and LDL levels are far from optimal in the Danish type 2 diabetes population and constitute a large potential for improvement.

Disclosure
H. Amadid: None. M. Bekker-Nielsen Dunbar: None. P.F. Rønn: Research Support; Self; Amgen, Danish Diabetes Academy. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. J.S. Knudsen: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk A/S. F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; Amgen, AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding
Amgen Inc.
1371-P: Effect of Omega-3 Supplementation in Pregnant Women with Obesity on Offspring Growth and Body Composition
Authors: MONTHE-DREZE CARMEN , ENSTAD SAMANTHA , SEN SARBATTAMA , DE MOUZON SYLVIE HAUGUEL , CATALANO PATRICK 
Published: June 2020

Background: Maternal obesity is a growing health burden associated with adverse cardiometabolic health outcomes in the offspring. Higher omega-3 polyunsaturated fatty acids (n3 PUFA) status in pregnancy is associated with higher birthweight. However, the effect of n3 supplementation, specifically in pregnant women with overweight and obesity, on fetal growth and adiposity has not been explored.
Objective: To examine the effect of n-3 supplementation in overweight and obese pregnancy on offspring anthropometry and body composition.
Methods: A secondary analysis of a double-blind randomized controlled trial of pregnant women with pre-pregnancy BMI≥ 25 randomized to daily DHA plus EPA (2 g/d) or placebo (wheat germ oil) from 10-16 weeks gestation to delivery. We compared the following newborn outcomes i) birthweight z-score derived from anthropometrics, ii) % adiposity, fat-mass and fat-free mass using PeaPodTM and skin fold thickness measurement, by randomization group using Student T-test and Wilcoxon rank-sum for bivariate analyses, and linear regression adjusting for gestational age (GA) and sex.
Results: For the 46 mother-child dyads with complete exposure and outcome data, median (IQR) maternal BMI was 30.2 (27.9, 35.5) kg/m2. Gestation was longer in the treatment vs. placebo group (40 (38.6,40.1) vs. 38.9 (38.0,39.4) weeks, p=0.009). Sex- and GA- specific birthweight z-score (-0.2 ± 0.7 vs. -0.6 ± 0.6-unit, p =0.035), but not birth length z-score (-0.3 ± 0.7 vs. -0.6 ± 0.6-unit, p =0.21), was higher in the treatment vs. placebo group. N-3 treatment was associated with higher fat-free mass (β 131.4g higher for treatment vs. control, 95% CI 3.1, 259.7) by skinfolds but not %bodyfat or fat mass at birth.
Conclusion: n-3 supplementation early in pregnancy in women with obesity increased birthweight, but this results from increased fetal lean mass accrual. Future investigations should explore the long-term impact of this intervention on offspring cardiometabolic health.

Disclosure
C. Monthe-Dreze: None. S. Enstad: None. S. Sen: None. S. Hauguel de Mouzon: None. P. Catalano: None.

Funding
National Institutes of Health (RHD057236); Case Western Reserve University/Cleveland Clinic Clinical and Translational Science Award (UL1RR024989)
1374-P: Association between Number of Abnormal Glucose Values and Severity of Fasting Plasma Glucose in IADPSG Criteria and Pregnancy Outcomes in Pregnant Women in South India
Authors: BALAJI BHAVADHARINI , ANJANA RANJIT MOHAN , DEEPA MOHAN , RAJENDRA PRADEEPA , RAM UMA , SARAVANAN PONNUSAMY , MOHAN VISWANATHAN 
Published: June 2020

Background: International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria recommends single step OGTT for diagnosis of gestational diabetes mellitus (GDM). The main concerns with IADPSG criteria are i) only one abnormal value is required and ii) fasting plasma glucose (FPG) cut point is too low. We report on association between number of abnormal glucose values and levels of FPG with pregnancy outcomes.
Methods: Pregnant women (n=1,044) were screened for GDM using IADPSG criteria. OGTT’s were classified based on the number of abnormal glucose values (any one value vs. more than one value), and FPG values (&lt;92mg/dl,92-100mg/dl,&gt;100mg/dl) and correlated with pregnancy outcomes. Odds Ratios were adjusted for age, BMI, family history of diabetes, history of GDM, birth weight, gestational week at diagnosis and delivery. For macrosomia, birth weight was not included.
Results: For caesarean sections, risk was higher in women with any one abnormal glucose value (OR:1.53;95%CI:1.08-2.16) and it increased further in those with more than one abnormal value (OR:1.58;95%CI:0.99-2.52), compared to women with normal glucose tolerance (NGT). Risk of caesarean section was also higher in women with FPG (92-100mg/dl) (OR:1.36;95%CI:0.86-2.15) and even higher in women with FPG &gt;100mg/dl (OR:1.88;95%CI:1.08-3.29) when compared to FPG &lt;92mg/dl. For macrosomia, women with any one abnormal value (OR:1.49;95%CI:0.96-2.33) and with more than one abnormal value (OR:1.07;95%CI:0.57-2.03) had higher risk compared to women with NGT. Risk of macrosomia was also higher in women who had FPG 92-100mg/dl (OR:1.04;95%CI:0.56-1.95) and FPG &gt;100mg/dl (OR:1.61;95%CI:0.83-3.10) compared to FPG&lt;92mg/dl.
Conclusion: The risk for poor pregnancy outcomes starts in those with one abnormal value in the OGTT or with FPG &gt;92mg/dl and the risk further increases with higher abnormal values.

Disclosure
B. Balaji: None. R. Anjana: None. M. Deepa: None. P. Rajendra: None. U. Ram: None. P. Saravanan: None. V. Mohan: None.
1378-P: Are Nutritional Habits Equally Associated with the Risk of Gestational Diabetes and Gestational Glucose Intolerance?
Authors: YABACI MERVE , SATMAN ILHAN , IDIZ CEMILE , TURKER FULYA , YUKSEL ATIL , OMER BEYHAN , DEMIREL BIRSEN , OZER EMEL 
Published: June 2020

Objective: The aim of this study is to investigate the relationships between the nutritional characteristics of pregnant women and the risk of gestational diabetes mellitus (GDM) and Gestational Glucose Intolerance (GGIT).
Materials and Method: Women were investigated for GDM during the 24th to 28th weeks of pregnancy. According to the two-step diagnostic approach, women with normal glucose tolerance (normal), those with only 1 high glucose (GGIT) and those with at least 2 high values (GDM) in OGTT were included in the study. There was 60 pregnant women in each group (mean age 31.6±5.4; range 19-46 years). Demographic and clinical characteristics of the participants were questioned and a 3-day food consumptions record were evaluated with BEBIS program.
Results: The mean weight, BMI and daily fiber intake in GDM group were significantly higher than the normal group. In the GDM and GGIT groups, the mean age, weight, daily carbohydrate (CHO) and protein intakes, and family history of diabetes were higher than those with normal group. Moreover, in the GDM group, daily fat intake was also significantly higher than the normal and GGIT groups. According to the separate models of logistic regression analysis; the age; daily protein, CHO and fat consumptions; having the first pregnancy and higher pre-pregnancy BMI (&gt;25 kg/m2) were associated with increased likelihood of GDM. Similarly, the age, daily protein consumption, history of giving birth to a macrosomic baby and current smoking were positively linked with the risk of GGIT.
Conclusion: Women’s nutritional habits (excessive CHO, fat and especially protein consumptions), phenotypic characteristics, family history of diabetes and poor obstetric history are similarly related to the risk of developing GDM and GGIT. Our results showed that in all women, particularly in those at high-risk for GDM who are planning pregnancy, a special attention should be given to general health and balanced diet, starting from pre-pregnancy.

Disclosure
M. Yabaci: None. I. Satman: None. C. Idiz: None. F. Turker: None. A. Yuksel: None. B. Omer: None. B. Demirel: None. E. Ozer: None.

Funding
Istanbul University
1379-P: Insufficient and Excessive Gestational Weight Gain across Midpregnancy to Delivery Are Associated with Multiple Adverse Maternal–Infant Outcomes: From the Camden Study
Authors: CHEN XINHUA , SCHOLL THERESA O. 
Published: June 2020

Retrospective studies on the relationship of gestational weight gain (GWG) with pregnancy outcomes such as preterm delivery and preeclampsia are inconsistent. We examined the association of longitudinally assessed GWG above (excessive) and below (insufficient) the IOM guidelines with maternal-infant outcomes from the Camden study - a large prospective cohort in young pregnant women (n=2,444, African-American 38%, Hispanic 45%, Caucasian 17%, age 22 ± 5.2 yr., BMI 26 ± 6 kg/m2). All of the analyses were multivariable adjusted. Excessive GWG was 48%, 53%, 56% and 58% in all pregnancies and insufficient GWG was 25%, 27%, 23%, 21% assessed at gestational week of 24, 28, 32 and at delivery, respectively. At delivery, insufficient GWG was associated with increased risk of preterm delivery (&lt;37 weeks’ gestation) (AOR 2.14, 95% CI 1.55-2.95) and small for gestational age (SGA, AOR 1.64, 95% CI 1.27-2.11). Excessive GWG was associated with higher risk of preeclampsia (AOR 1.56, 95% CI 1.08-2.27), large for gestational age (LGA, AOR 2.49, 95% CI 1.58-3.94) and a decreased risk of SGA (AOR 0.49, 95% CI 0.33-0.73). There was no significant difference in GDM. Similar results between insufficient or excessive GWG and risk of LGA, preeclampsia and SGA were observed in GWG assessed at week 24, 28, and 32, but no significant difference for preterm delivery. Significant linear trends among insufficient, adequate and excessive GWG at delivery with infant birth weight, birth length, chest and head circumferences were observed (p&lt;0.001 to p&lt;0.0001 for each). The relationship persisted and found as early as gestational week 24. Insufficient or excessive GWG across mid pregnancy to delivery are significantly associated with increased risk of several adverse maternal-infant outcomes. Maintaining adequate GWG from early pregnancy are important to improve the prognosis of maternal infant outcomes.

Disclosure
X. Chen: None. T.O. Scholl: None.

Funding
National Institutes of Health (R01MD007828)