www.AJOG.
org Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging
in both the basal and bolus rates was the morning segment (0500-
0900am) (Table 1).
CONCLUSION: In well-controlled T1DM, insulin requirements increase
three-fold across gestation mostly due to an increase in bolus rates
required to maintain control with meals. Basal insulin rates change
minimally across gestation and only make up 30% of the total daily
dose at 36 weeks. These data may aid with more precise insulin pump
management of T1DM in pregnancy.
255 The relationship between placental insufficiency
and glycemic control in diabetic mothers
Inna Landres1, Stephen T Chasen1
1
Weill Cornell Medical College, Obstetrics and Gynecology, New York, NY
OBJECTIVE: An improvement in glycemic control late in pregnancy
may reflect decreased food intake due to an expanding uterus. Alter-
natively, it could represent decreased production of placental growth
factors associated with insulin resistance secondary to diminishing
placental function. We sought to correlate such improvement in gly-
cemic control to placental insufficiency and maternal weight gain late
in pregnancy.
STUDY DESIGN: Retrospective cohort study of patients with pre-gesta-
tional or A2 gestational diabetes who received prenatal care at an
academic center clinic from June 2008 to June 2011. Medical records
were reviewed to identify changes in insulin or oral hypoglycemic
medications, episodes of hypoglycemia, weight gain during the last
month prior to delivery and clinical or pathologic evidence of placen-
tal insufficiency. Evidence of placental insufficiency included histo-
pathologic diagnosis of placental malperfusion or clinical diagnosis of
preeclampsia, IUGR or abruption. Statistical analysis was performed
using Student t test, Chi square, and Fisher’s exact tests.
RESULTS: 15 out of a total of 118 subjects had evidence of improved
glycemic control in the month prior to delivery based on either a
decrease in medication requirements or presence of hypoglycemia not
related to medication adjustments. No significant difference in age,
BMI, parity or type of diabetes was noted for subjects with improved
control. Subjects with improved control were significantly more likely
to have the diagnosis of placental insufficiency based on clinical only
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
Poster Session II
(p⫽0.003), pathological only (p⫽0.024), or combined parameters
(p⫽0.006). There was no significant difference noted between im-
proved glycemic control and weight gain in the month prior to deliv-
ery (p⫽0.207).
CONCLUSION: Diabetic mothers who demonstrate improvement in
their glycemic control in the month prior to delivery have higher rates
of placental insufficiency but no difference in their interval weight
gain. This suggests that underlying pathology of the placenta may be
responsible for the improvement in glycemic control observed in
some diabetic mothers.
256 Can we really diagnose type
2 diabetes during pregnancy?
Janet Burlingame1, Teresa Brink-Wong2, Frederico Rocha1,
Stacy Tsai1, Steve Shaha3, Lisa Bartholomew1
1
John A Burns University of Hawaii School of Medicine, Obstetrics
& Gynecology, Honolulu, HI, 2Kapiolani Hospital for Women and
Children, Fetal Diagnostic Center, Honolulu, HI, 3University of
Utah, Center for Policy and Public Administration, Draper, UT
OBJECTIVE: To identify the accuracy of diagnosing type 2 diabetes dur-
ing pregnancy using glycosylated hemoglobin (HbA1c) of ⬎6.5% (as
proposed by the 2010 International Association of Diabetes and Preg-
nancy Study Groups) at varying gestational ages.
STUDY DESIGN: A retrospective cohort of women diagnosed with ges-
tational diabetes and enrolled in the “Sweeter Choice” program from
2004 to 2011 were evaluated. This program performed antepartum
glycosylated hemoglobins (HbA1c) at enrollment into the program
and postpartum 75gm oral glucose tolerance tests (OGTT) to diag-
nose type 2 diabetes.
RESULTS: 403 women in the database entered care with a HbA1c of
⬎6.5%, and 86 women were diagnosed with overt diabetes postpar-
tum. Women with normal 2 hour values (200 mg/dl had average
HbA1c of 6.6%. In all, 31 women with HbA1c ⬎6.5% were diagnosed
with overt diabetes using the traditional 75gm OGTT in the postpar-
tum period. Sensitivities, specificities, positive predictive values
(PPV) and negative predictive values (NPV) were calculated (see table
1 for details). Similar findings were found for predictive values of
fasting glucose values at time of entry into care.
CONCLUSION: Although women with elevated postpartum 75gm
OGTT tended to enter care with higher HbA1c, we could not demon-
strate a clinically useful positive predictive value for defining overt
diabetes using the cut off of HbA1c ⬎6.5%. With larger numbers
perhaps a threshold value can be established for diagnosis at varying
time points in pregnancy. At this time it may be premature to diagnose
women with overt diabetes presenting in the antepartum with ele-
vated HbA1cs especially those presenting at later gestational ages.
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