1219-P: Central Obesity, Independent of General Obesity, Is Associated with Risk of Gestational Diabetes and Postpartum Prediabetes or Diabetes

General obesity measured by body mass index (BMI) is a major risk factor for gestational diabetes (GDM) and postpartum diabetes; however, the role of central obesity, assessed by waist-to-hip ratio (WHR) and waist circumference (WC), is understudied. We examined the prospective associations of general and central obesity with the risk of GDM and postpartum prediabetes or diabetes. Among 3,055 pregnant individuals in the prospective PETALS cohort, BMI was assessed preconceptionally and waist and hip circumference were measured at gestational weeks 10-13. Modified Poisson and Cox regression models assessed the risk of GDM (by Carpenter and Coustan criteria) and postpartum prediabetes or diabetes (by lab, diagnosis, and/or medication), respectively, in association with general obesity (BMI: Asian ≥27.5, non-Asian ≥30.0 kg/m2) and central obesity (WHR ≥0.85 or WC ≥88cm), adjusting for cofounders including continuous BMI. In total, 304 individuals developed GDM and 631 developed postpartum prediabetes or diabetes (mean ± SD follow-up: 4.3 ± 2.5 years). Compared to individuals without general and central obesity (by WHR), GDM risk increased by 1.91 (95% CI 1.10-3.31), 2.39 (1.67-3.43), and 2.69 (1.75-4.13)-fold for those with general obesity and without central obesity, without general obesity and with central obesity, and with both general and central obesity; postpartum prediabetes or diabetes risk increased by 1.70 (1.17-2.47), 1.45 (1.15-1.82), and 1.98 (1.44-2.72)-fold, respectively. Associations were strongest in Hispanic followed by Black individuals. Similar results were observed for central obesity by WC. Central obesity was a stronger risk factor for GDM than general obesity and exhibited incremental risk beyond general obesity for both GDM and postpartum prediabetes or diabetes. Clinicians should recognize the importance of screening for central obesity to identify pregnant individuals at higher risk of future dysglycemia. Disclosure Y. Zhu: None. R.F. Chehab: None. L. Chen: None. A. Ngo: None. M. Greenberg: None. A. Ferrara: None. Funding National Institute of Environmental Health Sciences (R01ES019196), National Heart, Lung, and Blood Institute (R01HL157666), National Institute on Minority Health and Health Disparities (R01MD018459), and Kaiser Permanente Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM).