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with type II. Mean gestational age at delivery was 36.7�2.9 weeks.Age, BMI and HbA1c level did not differ across categories. There wassignificant difference in mean placental weight across categories (519gvs. 478g vs. 376g respectively P�0.0001) and in fetal to placental ratioadjusted for gestational age (7.2 vs. 6.6 vs. 6.0 respectively P�0.0001).The IPC increased with adverse pregnancy outcome, 9.9 for the 165women without an adverse outcome, 10.1 for the 80 with one adverseoutcome, and 11.9 for the 48 patients with two or more adverse out-comes (P �0.03).CONCLUSION: In gravidas with preexisting diabetes, a higher frequencyof placental histopathological lesions is associated with adverse preg-nancy outcome.

292 The association between gestational diabetes mellitusnd long term maternal cardiovascular morbidity in aollow-up period of more than a decade

Roy Kessous1, Ilana Shoham-Vardi2, Gali Pariente1, Eyal Sheiner1

1Soroka University Medical Center, Ben-Gurion University of the Negev,epartment of Obstetrics and Gynecology, Faculty of Health Sciences, Beer

heva, Israel, 2Ben-Gurion University of the Negev, Epidemiology and Healthervices Evaluation, Beer sheva, Israel

OBJECTIVE: To investigate whether a diagnosis of gestational diabetesellitus (GDM) is a risk factor for subsequent long-term cardiovas-

ular morbidity.STUDY DESIGN: A population-based study comparing consecutivepregnancies of women with and without a diagnosis of GDM (with noprior cardiovascular diseases) was conducted. Deliveries occurredduring the years 1988-1999 and had a follow up until 2010. Incidenceof long-term cardiovascular hospitalizations and morbidity was com-

37 histopathological changes

pared between women with GDM and women who gave birth at the

S132 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2

same period with no GDM. Multiple logistic regression models wereconstructed to control for confounders.RESULTS: During the study period there were 47909 deliveries who

et the inclusion criteria; 4928 (10.3%) occurred in patients whoere diagnosed with GDM. During a follow-up period of more than

en years, as compared with women who gave birth at the same timeeriod, patients with GDM had higher rates of cardiovascular mor-idity including cardiac invasive and non invasive diagnostic proce-ures, simple as well as complex cardiovascular events, and hospital-

zations due to cardiovascular causes (table). Using multivariateogistic regression models, controlling for maternal age and ethnicity,DM remained an independent risk factor for both, maternal long-

erm cardiovascular simple events (adjusted OR� 2.7; 95% CI-2.4-3,� 0.001) and cardiovascular hospitalizations (adjusted OR� 2.3;

5% CI-2-2.5, P � 0.001).CONCLUSION: Gestational diabetes mellitus is an independent risk fac-tor for long term cardiovascular complications and for hospitalizationdue to a cardiovascular cause.

293 Relationship of early pregnancy waist to hip ratioersus body mass index with gestational diabetes andnsulin resistance

Sanmaan Basraon1

1Maternal-Fetal Medicine Units Network, The Eunice Kennedy Shriverational Institute of Child Health and Human Development, Bethesda, MD

OBJECTIVE: To determine the relation of early pregnancy waist to hipatio (WHR), a measure of central adiposity, versus body mass indexBMI), a measure of total body fat, with gestational diabetes mellitusGDM) and insulin resistance (IR).

STUDY DESIGN: Secondary analysis of randomized multicenter trial ofntioxidant supplementation versus placebo in nulliparous low-riskomen for prevention of pregnancy induced hypertension. Women

nrolled at 9-16 weeks gestation with data for WHR and BMI werencluded in the analysis for GDM (n�2300). Those with fasting glu-ose and insulin at 22-26 weeks gestation (n�717) were included inhe analysis for IR. The latter was determined using homeostasis

odel assessment of insulin resistance (HOMA-IR�[fastingnsulin(�U/ml)� fasting glucose(mmol/L)]/22.5; normal �75th

ile). WHR and BMI were categorized as normal (WHR�0.80;MI�25 kg/m2); overweight (WHR 0.80-0.84; BMI 25-29.9 kg/m2);nd obese (WHR�0.85; BMI�30 kg/m2). ROC curves and logistic

regression models adjusting for maternal demographics, gestationalage at enrollment, alcohol and smoking status, were used to evaluatethe association of WHR and BMI with GDM and HOMA-IR.RESULTS: The risks of GDM and IR by WHR and BMI categories arehown in the Table. Compared to normal, the risks of GDM or IR wereignificantly higher in obese by BMI or WHR and in overweight byMI, but not by WHR. Overall, BMI was a better predictor of IR (AUC.71 and 0.65 for BMI and WHR respectively, p�0.03) but similar toHR for GDM (AUC 0.68 and 0.63 for BMI and WHR respectively,

�0.18). When evaluated together, the rate of GDM and IR was highestn the group that was obese by both definitions, compared to either onelone, however, the difference did not reach statistical significance.

CONCLUSION: Increased WHR and BMI in early pregnancy are associ-ated with development of IR and GDM. BMI is a better predictor of IRcompared to WHR. Adding WHR measurement to BMI does not

improve its ability to detect GDM or IR.

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