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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 (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 >100mg/dl (OR:1.88;95%CI:1.08-3.29) when compared to FPG 100mg/dl (OR:1.61;95%CI:0.83-3.10) compared to FPG Conclusion: The risk for poor pregnancy outcomes starts in those with one abnormal value in the OGTT or with FPG >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.

Glucagon-like peptide 1 (GLP-1) levels may be reduced in type 2 diabetes, but whether a similar impairment exists in gestational diabetes mellitus (GDM) has not been established. We studied this in a prospective cohort study of pregnant women (n = 144) during oral glucose tolerance test (OGTT). GLP-1, glucose, and insulin were sampled at 30-min intervals during a 2-h 75-g OGTT, and indices of insulin secretion and sensitivity were calculated. In a nested case-control study, women with GDM (n = 19) had 12% lower total GLP-1 secretion area under the curve (AUC) compared with control subjects matched for age, ethnicity, and gestational age (n = 19), selected from within the lowest quartile of glucose120 min values in our cohort. GDM had lower GLP-1 response in the first 30 min (19% lower GLP-130 min and 17% lower AUC0–30 min) after adjustment for possible confounders. Their glucose levels began to diverge at 30 min of the OGTT with increasing insulin levels, and by 120 min, their insulin levels were three times higher. In a secondary cohort of 57 women that included “high-normal” glucose120 min values, low GLP-1 AUC0–30 min was independently associated with lower indices of insulin secretion and sensitivity. In conclusion, we have observed that women with GDM have lower GLP-1 response at 30 min of an OGTT and hyperglycemia at 120 min despite significant hyperinsulinemia.

Background: The pathogenesis of gestational diabetes mellitus (GDM) is not fully understood and combining novel biomarkers with established risk factors could improve early prediction of GDM. Low vitamin B12 (B12) levels have been linked to obesity, insulin resistance and GDM but its predictive ability in early pregnancy as a risk factor for later GDM has not been proven. Methods: Micronutrients in Pregnancy as a Risk factor for gestational diabetes and Effects on mother and baby (PRiDE) is a cohort study of pregnant women at high risk of developing GDM (n=4751 recruited). GDM was diagnosed by a 2-hour 75g OGTT according to UK NICE criteria (fasting blood glucose, FBG ≥5.6mmol/l or 2-hour BG ≥7.8mmol/l). B12 and folate were measured by electrochemiluminescence and deficiency defined as ≤200pg/ml and ≤3ng/ml respectively. Multiple linear and logistic regression models were done with covariates including age, BMI, ethnicity, parity, smoking status, gestational weight gain and folate levels. Results: The data from the first 3412 women with complete B12/folate and OGTT results were analysed (median (range) gestational age 12+5(4+3, 16+0) and 26+4 (15+0, 32+1) weeks respectively). Mean (±SD) age was 30.7±5.2 years, BMI 30.8±7.3 kg/m2 and 56.0% were obese. 11.5% had GDM and B12 and folate deficiency rates were 10.2% and 0% respectively (p>0.05 in GDM vs. no-GDM). GDM women had similar B12 and folate values to no-GDM (346±151 vs. 357 ± 155 pg/ml and 19.8±12.6 vs. 18.8±12.1 ng/ml respectively, adjusted p>0.05). B12 was negatively correlated with BMI (Pearson’s r=-0.24, p Conclusions: Early pregnancy B12 values were predictive of high FBG in late gestation. Low B12 levels may be an independent risk factor for GDM, particularly in obese women. Disclosure N. Sukumar: None. A. Antonysunil: None. Y. Ghebremichael-Weldeselass: None. I. Goljan: None. C. Bagias: None.