1234-OR: Do First-Trimester Metabolic or Lipid Measures Improve Prediction of GDM and LGA?

Introduction and Objective: In GO MOMs, early pregnancy OGTT did not sufficiently improve prediction of gestational diabetes (GDM) or large-for-gestational age birthweight (LGA) beyond clinical factors to warrant universal first-trimester screening. This secondary analysis evaluated if early metabolic or lipid measures improved predictions of these outcomes. Methods: Singleton gravidas without preexisting diabetes from 9 US centers had 75g OGTT, metabolic measures [Matsuda insulin sensitivity (IS), β-cell function (βCF)] and fasting lipids [free fatty acids (FFA), triglycerides (TG)] at 10-14 weeks gestation. Logistic regression models evaluated addition of IS and βCF to clinical factors (age, BMI, history of GDM or macrosomia) and OGTT values for prediction of GDM at 24-28 weeks using Carpenter-Coustan criteria. For prediction of LGA, FFA and TG were added to the models. Binary variable cutoffs maximized area under the receiver operating characteristic curve (AUC) in a training data set (4 centers), with results validated in remaining centers. Results: Of 2178 GO MOMs participants, 91% completed OGTTs (15% GDM) and 96% had live births (11% LGA). Neither IS nor βCF improved predictive accuracy compared to models with clinical factors or clinical factors + OGTT for GDM. For LGA, neither metabolic measures nor lipids improved prediction (Figures). Conclusion: Metabolic or lipid measures in early pregnancy do not improve prediction of GDM or LGA over clinical factors + OGTT. Disclosure E. LeBlanc: None. A. Kuang: Stock/Shareholder; Current; Dexcom, Inc. F.L. Facco: None. M. Feghali: None. W. Grobman: None. A.A. Killeen: None. W. Lowe: None. A. Merriam: None. M. Mourad: None. C. Oshiro: None. C. Powe: Research Support; Current; Dexcom, Inc. Other - Associate Editor of Diabetes Care, Honoraria for Educational Materials; Current; American Diabetes Association. Other - Royalties for Up To Date chapters; Current; Wolters Kluwer (Up To Date). Other - Speaker; Ended; Medscape. U. Reddy: None. D. Rouse: None. J. Sherr: Other - research support, consultant, advisory board member; Current; Abbott Diabetes. Other - advisory board member, consultant; Current; Vertex Pharmaceuticals Incorporated. Consultant; Current; Ypsomed AG. Research Support; Current; Dexcom, Inc., JDRF, Provention Bio, Inc., National Institutes of Health. Other - research support, consultant, advisory board member; Current; Insulet Corporation, Medtronic. Research Support; Current; Sanofi. Advisory Panel; Current; sequel med tech. A.C. Spadola: None. K. Vesco: None. E. Werner: None. L.M. Yee: None. N. Zork: None. D. Scholtens: None. P. Catalano: None. Funding The GO MOMs study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases. U01DK123795 to Massachusetts General Hospital; U01DK123791 to Kaiser Permanente; U01DK123759 and U01DK123745 to Northwestern University; U01DK123799 to Yale University; U01DK123783 to Women & Infants Hospital of Rhode Island. Dexcom provided the CGM systems used in the study free of charge.