bluuebunny/crossref_metadata_2025_split huggingface dataset:
1035-P: Early Pregnancy Alterations in the Metabolome of Obese Women
Authors: BANDRES-MERIZ JULIA , KUNZ CHRISTINA , HAVELUND JESPER , FÆRGEMAN NILS J. , HURTADO DE MENDOZA IRENE , MAJALI-MARTINEZ ALEJANDRO , ENSENAUER REGINA , DESOYE GERNOT 
Published: May 2022

Obesity in human pregnancy associates with changes in the glucose-insulin axis. We hypothesized that these changes affect the maternal metabolome already in the first trimester, and thus aimed to identify these metabolites. We performed untargeted metabolomics (HPLC-MS/MS) on maternal serum (n=111, gestational age week 4+0-11+6) . In addition to BMI and leptin as measures of obesity and adiposity, we metabolically phenotyped women by their fasting glucose, C-peptide and insulin sensitivity index (ISHOMA) . We identified 2449 serum metabolites of which 277 were annotated. After stringent filtering employing a combination of univariate and multivariate analyses with multiple confounders and machine learning methods (Partial Least Squares Discriminant Analysis, Random Forest and Support Vector Machine) we identified 14 metabolites robustly and significantly (FDR&lt;0.1) associated with at least one exposure (BMI, leptin, glucose, C-peptide, ISHOMA) . Among these, palmitoleoyl ethanolamine (POEA) , an endocannabinoid-like lipid endogenously synthesized from palmitoleic acid, was consistently associated with C-peptide in all analyses explaining 21% of variance in POEA concentration. Decreased POEA levels in T2D and its affinity for the novel endocannabinoid GRP1receptor made it a strong candidate for further exploration. In network analysis most metabolites correlating with POEA and regulated by C-peptide, were amino acids or dipeptides (n=9, 35%) , followed by lipids (n=7, 27%) . We conclude that the metabolome of overweight/obese pregnant women is already altered early in pregnancy. Changes of POEA concentration in pregnant women with obesity-associated hyperinsulinemia may reflect dysfunctional endocannabinoid signalling and, thus, compromise pregnancy maintenance.

Disclosure
J.Bandres-meriz: None. C.Kunz: None. J.Havelund: None. N.J.Færgeman: None. I.Hurtado de mendoza: None. A.Majali-martinez: None. R.Ensenauer: None. G.Desoye: None.

Funding
Austrian Science Fund 339 FWF (DOC 31-B26) and the Medical University Graz through the PhD Program Inflammatory Disorders in Pregnancy (DP-iDP)
1038-P: Exposures to Hyperglycemia in the Embryonic Period and to Breast Milk from Mothers with Hyperglycemia Affect Glucose Tolerance with Higher Glucagon-Like Peptide-1 Secretion
Authors: ISHII KEITARO , SASAKI JUNKO , SUGAI KEIJI , ITO MARIKO , IWASAKI HAJIME , HARA NATSUKO , AIERKEN MAIERHABA , LI GUOJIAO , SUWANAI HIROTSUGU , ODAWARA MASATO , SUZUKI RYO 
Published: May 2022

Exposure to hyperglycemia during pregnancy results in diabetes in offspring. However, its underlying mechanisms are unclear. We therefore focused on the glucose metabolism of the offspring who were exposed to hyperglycemia in uterus or who were breast-fed from mothers with hyperglycemia. ICR female mice received single intraperitoneal injection (i.p.) of streptozotocin at six weeks old as the model of mother with diabetes (MD) . An additional group of mice received citric acid buffer injection, instead, as the model of mother with normal glycemia (MNG) . We established the model exposed to hyperglycemia in the uterus (EHU) by switching offspring from MD to MNG right after birth. As the model exposed to the breast milk of mothers with hyperglycemia (EBM) , the offspring from MNG were moved to MD right after birth. To eliminate the effects of cross fostering, offspring from MNG were fostered by another MNG as the control group. In intraperitoneal glucose tolerance test (IPGTT) at P60, EHU and EBM didn’t show increase of blood glucose level (BG) nor decrease of plasma insulin level but showed in oral glucose tolerance test (OGTT) at P50 (AUC of BG: p &lt; 0.in EHU, p &lt; 0.00in EBM, AUC of plasma insulin level per BG: &lt;0.00in EHU and EBM) . From these conflicting results, we suspected the participation of glucagon-like peptide-1 (GLP-1) . However, the AUC of plasma total GLP-1 and active GLP-1 levels were higher in OGTT. Since we didn’t observe any difference in beta cell area per whole pancreas section by immunostaining, EHU and EBM might have GLP-1 resistance.

Disclosure
K.Ishii: None. M.Odawara: Other Relationship; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo, Daiichi Sankyo, Dainippon Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Novo Nordisk, Omnipod, ONO PHARMACEUTICAL CO., LTD., Sanofi K.K., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Co.,Ltd., Teijin Pharma Limited. R.Suzuki: Consultant; Novo Nordisk A/S, Other Relationship; Daiichi Sankyo, Eli Lilly Japan K.K., MSD K.K., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Research Support; Boehringer Ingelheim Japan, Inc., LifeScan, Mitsubishi Tanabe Pharma Corporation. J.Sasaki: None. K.Sugai: None. M.Ito: None. H.Iwasaki: None. N.Hara: None. M.Aierken: n/a. G.Li: None. H.Suwanai: None.
1046-P: Role of Serum C1q/TNF-Related Protein 9 in Predicting Gestational Diabetes Mellitus
Authors: LIU YUTING , SHI MIN , WANG ZIWEI , ZHENG XIYIN , ZHANG HONG 
Published: May 2022

Background/Aims: C1q/TNF-related protein 9 (CTRP9) as a member of CTRP super family, participates in the regulation of glycolipid metabolism. However information regarding the role of CTRP9 in gestational diabetes mellitus (GDM) is scarce. The current study aims to ascertain the relationship between serum CTRP9 levels and GDM.
Methods: A total of 35 GDM patients and 37 normal pregnant women were enrolled in our study. Serum CTRP9 levels were measured via enzyme-linked immunosorbent assay (ELISA) . Fasting insulin (FINS) , IL-6, Leptin, MCP-1, TNF-α and IL-1β were quantified using Luminex-xMAP technology. Anthropometric data and biochemical parameters were also obtained or measured.
Results: The results showed that fasting plasma glucose (FPG) , one hour plasma glucose (1-h PG) , 2 hour plasma glucose (2-h PG) , FINS, IL-6, Leptin, TNF-α and CTRP9 during GDM group were significantly higher than the control group. In addition, serum CTRP9 levels had a significantly positive correlation with FPG (r = 0.559, P &lt; 0.001) , 1h-PG (r = 0.539, P &lt;0.0) , 2h-PG (r = 0.378, P = 0.001) , FINS (r = 0.253, P = 0.032) , HOMA-IR (r = 0.382, P = 0.001) , IL-6 (r = 0.283, P = 0.016) , and TNF-α (r = 0.266, P = 0.024) . Furthermore, binary logistic regression demonstrated that HOMA-IR and CTRP9 were independent risk factors for GDM. The AUC-ROC indicated that the diagnostic efficiency of combined CTRP9 and HOMA-IR was much higher than a single index.
Conclusions: The high level of serum CTRP9 is an independent risk factor for GDM. Moreover, the combination of serum CTRP9 and HOMA-IR were more efficient in diagnosing GDM.
Key words: Gestational diabetes mellitus, CTRP9, insulin resistance

Disclosure
H. Zhang: None.
105-OR: Microbiome-Derived Metabolite Signatures in Early- to Midpregnancy for Risk of Gestational Diabetes (GDM)
Authors: ZHU YEYI , SUSARLA SITA MANASA , BARUPAL DINESH , NGO AMANDA , CHEHAB RANA F. , FIEHN OLIVER , FERRARA ASSIAMIRA 
Published: May 2022

Pre-diagnostic disturbances in gut microbiome and metabolome have been associated with an increased risk of diabetes in non-pregnant populations. However, such prospective studies in pregnant women are scant. We aimed to develop and validate microbiome-derived metabolite predictive markers in early to mid-pregnancy for GDM. We designed a nested case-control study (91 GDM, 180 non-GDM; discovery set) and a random subsample (42 GDM, 372 non-GDM; validation set 1) from the PETALS cohort, and a case-control study from the GLOW trial (35 GDM, 70 non-GDM; validation set 2) . We collected fasting serum untargeted metabolomics data at gestational weeks (GW) 10-13 and 16-by gas chromatography/time-of-flight mass spectrometry (TOF-MS) , liquid chromatography (LC) /quadrupole TOF-MS, and hydrophilic interaction LC/quadrupole TOF-MS. Among 1167 annotated metabolites, 193 microbiome-derived metabolites were identified from the Virtual Metabolic Human Database. Multivariate enrichment analysis examined metabolite-GDM associations. Ten-fold cross-validated LASSO prediction models identified metabolite signatures for GDM. At GW 10-13, the branched-chain amino acids cluster was marginally, positively associated with GDM risk (FDR = 0.073) . At GW 16-19, the ceramides, pyridines, pyrimidine nucleosides, and unsaturated fatty acids clusters were significantly, positively associated with GDM risk (all FDR &lt;0.05) . A 38-metabolite panel at GW 10-13 outperformed the model using conventional risk factors including fasting glucose (discovery AUC: 0.915 vs. 0.743; validation 1: 0.865 vs. 0.731; validation 2: 0.970 vs. 0.742; P &lt;0.01) . Similar results were observed for a 21-metabolite panel at GW 16- (discovery AUC: 0.842 vs. 0.760; validation 1: 0.840 vs. 0.774; P &lt;0.01) . Panels of microbiome-derived metabolites in early to mid-pregnancy can predict GDM risk beyond conventional risk factors, suggesting the role of microbiome-metabolome-host interactions in GDM.

Disclosure
Y.Zhu: None. S.Susarla: None. D.Barupal: None. A.Ngo: None. R.F.Chehab: None. O.Fiehn: None. A.Ferrara: n/a.

Funding
National Institutes of Health Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Program (K12HD052163) ; National Institute of Diabetes and Digestive and Kidney Diseases (K01DK120807)
1050-P: COVID-Severity and Diabetes in Pregnancy
Authors: RIVERA ADRIANA NIGAGLIONI , PAUL RACHEL , FROLOVA ANTONINA I. , RAGHURAMAN NANDINI , KELLY JEANNIE , ODIBO ANTHONY O. , CARTER EBONY B. 
Published: May 2022

Diabetes and pregnancy are independently associated with increased risk of severe COVID-infection. However, little is known about the relationship between severe COVID-and diabetes in pregnancy. We sought to determine whether diabetes in pregnancy was associated with increased risk of COVID-infection and severity. We conducted a case-control study of all delivering patients at a tertiary hospital from June 2020-September 2021 and accepted universal COVID-testing. Patients with no COVID-test results were excluded. The proportion of patients with any COVID-infection and severe COVID-infection during pregnancy were compared between patients with and without diabetes using chi-square. Severe COVID-was defined as meeting any WHOOSCI or NCPERET criteria (dyspnea, respiratory rate ≥30 breaths per minute, blood oxygen saturation of ≤93%, PaO2/FiO2 &lt;300, lung infiltrates involving &gt;50% on imaging, non-invasive ventilation or high flow oxygen use, intubation and mechanical ventilation, or ventilation with additional organ support) . Of 4,253 patients in our analysis, 292 (6.9%) had COVID-during pregnancy. Demographic characteristics were similar between patients with a COVID-infection in pregnancy and those that were negative; 71 (24.3%) had a severe infection, and 451 (10.6%) had diabetes. There was no difference between patients with and without diabetes in incidence of COVID-infection (9.6% vs. 10.7%, p=0.56) or severe COVID-infection (11.3% vs. 9%, p=0.58) . Diabetes in pregnancy was not associated with increased risk of COVID-infection or severe infection. Future research in larger samples may further elucidate the association between diabetes and COVID-infection in pregnancy.

Disclosure
A.Nigaglioni rivera: None. R.Paul: None. A.I.Frolova: None. N.Raghuraman: None. J.Kelly: None. A.O.Odibo: None. E.B.Carter: None.
1058-P: Diabetic Ketoacidosis during Pregnancy: Maternal Characteristics and Pregnancy Outcomes
Authors: DHANASEKARAN MAHESWARAN , MOHAN SNEHA , ERICKSON DANA , SHAH PANKAJ , SZYMANSKI LINDA M. , VELLA ADRIAN , EGAN AOIFE M. 
Published: May 2022

Diabetic ketoacidosis (DKA) during pregnancy is an obstetric emergency associated with morbidity and mortality. As this condition is rare (affecting 1-3% pregnant women with preexisting diabetes) , available data are limited. The aim of this retrospective cohort study is to present comprehensive data on maternal characteristics and pregnancy outcomes for women with DKA who attended our center for prenatal care from 2001-21. In total 71 DKA episodes were identified in 58 women, of whom 86% (n=50) had type 1 diabetes mellitus and 83% (n=48) were White. The mean (±SD) maternal age was 28 (±7) years and diabetes duration was (±7) years. Pregnancy loss during or within 1 week of the DKA episode occurred in 17% (6 miscarriages and 4 stillbirths) . There were no maternal deaths. Women were poorly prepared for pregnancy [mean 1st trimester HbA1c 9.3 (±2.5) %]. Social stressors were present in 52% (n=30) and 24% (n=14) reported smoking. The mean gestational age at DKA was 25.4 weeks (16.3 weeks for pregnancies with fetal demise vs. 27.5 weeks for livebirths, p&lt;0.001) . Insulin non-adherence was the most common precipitating factor (40%) , followed by infection (23%) , and a new diagnosis of type 1 diabetes (10%) . Pre-existing hyperemesis was associated with fetal demise (31%, n=4 vs. 3%, n=2 among livebirths; p=0.004) . The mean plasma glucose at presentation was 362 mg/dL and the β-hydroxybutyrate was 4.2 mmol/L, with 28 (39%) women requiring intensive care unit (ICU) admission. Among livebirths, the mean gestational age at delivery was 32.7 weeks with 41% (n=21) requiring emergency cesarean. Large for gestational age occurred in 29% (n=17) and 8% (n=4) had shoulder dystocia. Congenital anomaly was present in 10% (n=5) . Neonatal hypoglycemia occurred in 60% (n=29) and neonatal ICU admission was required in 52% (n=25) .
In summary, pregnancies affected by DKA continue to be associated with numerous adverse pregnancy outcomes. Future work should focus on optimizing prevention strategies in high-risk women.

Disclosure
M.Dhanasekaran: None. S.Mohan: None. D.Erickson: None. P.Shah: None. L.M.Szymanski: None. A.Vella: Advisory Panel; Crinetics Pharmaceuticals, Inc., Rezolute, Inc., vTv Therapeutics, Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None.

Funding
National Institutes of Health (K12 HD065987/HD/NICHD)
106-LB: Comparable Total Exposure of Once-Weekly Insulin Icodec between Different Subcutaneous Injection Regions
Authors: PLUM-MOERSCHEL LEONA , ANDERSEN LIZETTE R. , HANSEN SOLVEJG , HÖVELMANN ULRIKE , KRAWIETZ PATRICIA , KRISTENSEN NIELS R. , LANG LEHRSKOV LARS , HAAHR HANNE 
Published: May 2022

People with diabetes may inject s.c. insulin in different body regions. To address if choice of injection region affects insulin icodec exposure and glucose-lowering effect, this study compared icodec administration in different s.c. injection regions. In a randomized, open-label, three-period crossover trial, 25 individuals with T2D on basal insulin (22 males; mean±SD age 60±7 yrs, BMI 30.7±4.6 kg/m2) received single s.c. icodec doses (5.6 U/kg) in the thigh, abdomen and upper arm (9-13 weeks washout) . Blood was sampled for pharmacokinetics (PK) until 840 h (35 days) post-dose. Glucose-lowering effect was assessed at 36-60 h post-dose in an automated glucose clamp (target 135 mg/dL) . Total icodec exposure (AUC0-∞,SD) was similar after single-dose s.c. injection in the thigh, abdomen and upper arm (Table) . Maximum concentration (Cmax,SD) was higher for abdomen/upper arm vs. thigh. Extrapolation of PK profiles to steady state using a PK model showed smaller differences in Cmax,SS for abdomen/upper arm vs. thigh than after single dose. Partial glucose-lowering effect 36-60 h after single dose (AUCGIR,36-60h,SD) was comparable across injection regions (geom. mean [CV%] of 1961 [51], 2130 [52] and 2391 [40] mg/kg for thigh, abdomen and upper arm) .
In conclusion, insulin icodec can be administered s.c. in the thigh, abdomen or upper arm with essentially similar exposure and glucose-lowering effect.

Disclosure
L. Plum-moerschel: Other Relationship; Eli Lilly and Company, Gan & Lee Pharmaceuticals, Novo Nordisk A/S. L. R. Andersen: None. S. Hansen: None. U. Hövelmann: None. P. Krawietz: None. N. R. Kristensen: Employee; Novo Nordisk. L. Lang lehrskov: Employee; Novo Nordisk A/S. H. Haahr: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S.

Funding
Novo Nordisk
106-OR: Fetal Sex Influences Maternal Insulin and Glucose Metabolism in Pregnancy
Authors: MULLINS THOMAS P. , GIBBONS KRISTEN S. , MADSEN LENE R. , MA RONALD C. , TAM WING H. , CATALANO PATRICK , SACKS DAVID A. , BARRETT HELEN L. , MCINTYRE DAVID 
Published: May 2022

Aims and Hypothesis: Women carrying a male fetus are suggested to have altered maternal glucose and insulin dynamics and increased rates of GDM, but current literature remains inconclusive. We aimed to determine the relationship between fetal sex and maternal glucose and insulin metabolism and assess whether inclusion of fetal sex improves prediction of IADPSG GDM.
Methods: Using blinded data from five Hyperglycaemia and Adverse Pregnancy Outcome study centres, we examined maternal metabolic data at mean gestational week 28 in 6337 untreated women. Stratifying women by either male (n = 3273) or female fetus (n = 3064) we analysed data from the 75g OGTT, estimates of insulin secretion (Stumvoll first phase) and sensitivity (Matsuda index) and their product (oral Disposition index) using multiple linear regression analysis. To assess the relationship and predictive ability of fetal sex and GDM we utilised multiple logistic regression and receiver operating characteristic curve analysis.
Results: Women carrying a male fetus were found to have a modest increase in fasting plasma glucose (4.52 vs. 4.44 mmol/L; P=0.008) and 1 h glucose (7.57 vs. 7.46 mmol/L; P=0.015) during OGTT which translated into an overall increase in the OGTT z score (0.vs. 0.02; P=0.005) . The Matsuda (β: -0.06; 95% CI [-0.10, -0.02]; P=0.008) and oral Disposition index (β: -0.07; 95% CI [-0.11, -0.02]; P=0.005) were significantly reduced in women carrying a male fetus after correction for established maternal clinical risk factors. Women carrying a male fetus were not at higher odds of developing GDM in adjusted (aOR: 1.04; 95% CI [0.9, 1.19]; P=0.6) or unadjusted (OR: 1.09; 95% CI [0.96, 1.25]; P=0.16) models.
Conclusion/interpretation: The male fetus is associated with increased maternal fasting and postprandial glucose with concomitant decreased insulin sensitivity and β-cell compensation. The alterations in maternal glucose and insulin dynamics associated with having a male fetus does not translate into a clinical diagnosis of GDM.

Disclosure
T.P.Mullins: None. K.S.Gibbons: None. L.R.Madsen: None. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. W.H.Tam: None. P.Catalano: None. D.A.Sacks: None. H.L.Barrett: None. D.Mcintyre: None.
1060-P: Exploring Differences in the 24-Hour Glucose Cycle by Physical Activity Level in Women with Pregnancy Hyperglycemia
Authors: EHRLICH SAMANTHA F. , RAND BETHANY G. , ZITE NIKKI , FORTNER KIMBERLY B. , PAUDEL ALISSA M. , PETERSON CHRISTINA , MAPLES JILL M. 
Published: May 2022

Physical activity (PA) improves glucose levels. PA’s impact on the 24-hour glucose cycle in pregnancy hyperglycemia is unknown. This study examined baseline data from women participating in a small pilot feasibility randomized controlled trial. At baseline, they completed a survey which included the Stanford Leisure-Time Activity Categorical Item (L-Cat) for comparison to national PA recommendations. PA over the past month was assessed. Dexcom G6 CGMs linked to blinded receivers were worn for 7 days. Typical 24-hour glucose functions were estimated with B-splines and generalized regression analyses controlling for gestational diabetes (GDM) conducted in JMP. CGM was available for 14 participants; 4 (29%) had GDM and 3 (21%) reported meeting PA recommendations. Mean glucose was 91.5 mg/dl (SD 17) for sufficient PA and 93.6 mg/dl (SD 20) for insufficient PA. Figure 1 displays the 24-hour glucose functions (3rd degree polynomials with 17 knots) for sufficient PA (red) versus insufficient PA (blue) . Lower glucose was observed in the early morning, i.e., from midnight through approximately 6am and likely fasted, in sufficient versus insufficient PA, but the difference did not attain statistical significance. Glucose was higher in those with GDM, controlling for PA (P &lt; .05) . Findings in a small sample of women with pregnancy hyperglycemia suggest that PA may improve early morning glucose.

Disclosure
S.F.Ehrlich: None. B.G.Rand: None. N.Zite: None. K.B.Fortner: Other Relationship; Pfizer Inc. A.M.Paudel: None. C.Peterson: None. J.M.Maples: None.

Funding
K01DK105106
1062-P: Outcomes in Pregnancies with Preexisting Type 1 Diabetes vs. Healthy Controls over a 14-Year Period
Authors: KAUR RAVINDER JEET , RIZVI SHAFAQ RAZA , DESJARDINS DONNA , ZANILETTI ISABELLA , REID COREY , MCCRADY-SPITZER SHELLY K. , TRINIDAD MARI CHARISSE , KUDVA YOGISH C. 
Published: May 2022

Background: We studied maternal and neonatal outcomes in pregnancies with preexisting T1D and matched controls (age, gravida, BMI) to address limited data in this field in the US.
Methods: Pregnancies (n=165) in preexisting T1D and matched healthy controls (n=165) were retrospectively studied (01/01/20to 12/1/2020) at a single center. Conditional logistic regression, Wilcoxon signed rank and Wilcoxon rank sum tests were used for analyses.
Results: Pregnancies with T1D had significant hypertension [32% (19% pre-existing) vs. 10% (2% pre-existing) , p&lt;0.01], preeclampsia (28% vs. 7%, p&lt;0.01) , thyroid dysfunction (24% vs. 7%, p&lt;0.01) and were affected by polyhydramnios (14% vs. 4%, p&lt;0.01) , macrosomia affecting labor (16% vs. 2%, p&lt;0.01) , increased C-section’s rate (16% vs. 7%, p=0.02) and complicated C- sections (6% vs. 1%, p=0.04) . In T1D, four neonates had cardiac complications and 14 (8.5%) were large for gestational age compared to 2 (1%) controls. More neonates in T1D were preterm (34.5% vs. 14.5%, p&lt;0.01) , with fetal anomalies (15.8% vs. 4%, p&lt;0.01) , Respiratory Distress Syndrome (25.5% vs. 7%, p&lt;0.01) , apnea (14% vs 5.5%, p=0.01) , other pulmonary complications (13% vs. 5%, p&lt;0.01) and respiratory failure (11% vs. 3%, p=0.01) . Significant hypoglycemia (16% vs. 7%) , sepsis (7% vs. 1%) , jaundice (70% vs. 36%) and upper GI complications (39% vs. 16%) were observed in neonates born to mothers with T1D. T1D neonates had higher birth weight (p =0.01) and were born early (37.2 vs. 39 wks, p&lt;0.01) . HbA1c &gt;7% was associated with above neonatal complications compared to those who with HbA1c &lt;6.7%.
Conclusion: Pregnancies with type 1 diabetes continue to be associated with high maternal and neonatal morbidity and need urgent development of interventions to improve outcomes.

Disclosure
R.Kaur: None. S.Rizvi: None. D.Desjardins: None. I.Zaniletti: None. C.Reid: None. S.K.Mccrady-spitzer: None. M.Trinidad: None. Y.C.Kudva: Advisory Panel; Novo Nordisk, Research Support; Dexcom, Inc., Hemsley Charitable Trust, JDRF, National Institutes of Health, Roche Diabetes Care, Tandem Diabetes Care, Inc.