Poster Session IV ajog.

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diabetes and 2) mean glucose levels at 1 and 2 weeks post CONCLUSION: The presence of moderate/severe fatty liver on ultra-
randomization. sound in early pregnancy was associated with the increased risk of
RESULTS: 138 women underwent randomization 62 to VBA and 76 delivering an LGA infant, even after adjustment for GDM.
to control. 8 women dropped out of the study after randomization
(3 control, 5 VBA) and were not included in the analysis.
Randomization occurred at a mean gestational age of 30 weeks. No
differences were noted in baseline characteristics. 44.3% of women
in the control group required medical management of GDM vs
34.4% in the VBA group (P¼ 0.285). No differences were noted in
mean fasting or postprandial glucose levels. Mean weekly step count
was 44,433 in the control group and 56,181 in the VBA group (P¼
0.1). There were no differences in mean birthweight (3270g vs 3253g
P¼0.85) or vaginal delivery rate (62.9% vs 60% P¼0.86).There were
no adverse obstetric outcomes in the VBA group which is reassuring.
CONCLUSION: The addition of the VBA platform to routine man-
agement of GDM did not improve glycemic control or reduce the
need for medical management of GDM.

791 Nonalcoholic fatty liver disease in the first

trimester as a risk factor for large-for-gestational-
age birthweight: a prospective study
Seung Mi Lee1, Joong Shin Park1, Errol R. Norwitz2, Ja Nam Koo3,
Ig Hwan Oh3, Byoung Jae Kim4, Sun Min Kim4, Sang Yoon Kim1,
Kyoung Min Kim5, Soo Heon Kwak1, Won Kim4, Sae Kyung Joo4,
Sue Shin4
1
Seoul National University College of Medicine, Seoul, Korea, Republic of,
2
Tufts University School of Medicine, Boston, MA, 3Seoul Women’s Hospital,
Incheon, Korea, Republic of, 4Seoul Metropolitan Government Seoul
National University Boramae Medical Center, Seoul, Korea, Republic of,
5
Yeonsei University College of Medicine, Seoul, Korea, Republic of
OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is a recognized
hepatic manifestation of metabolic disease in adults and has been
associated with the development of gestational diabetes (GDM).
Hepatic insulin resistance can result in increased release of glucose
(from glycogen breakdown) and free fatty acids (due to enhanced
lipolysis), which can lead in turn to fetal overgrowth. However, the
relationship between maternal metabolic factors (such as circulating
levels of triglycerides, free fatty acids, or leptin) and excessive fetal
birthweight has not been carefully examined. In this study, we
evaluated the relationship between NAFLD and the subsequent risk
of large-for-gestational-age (LGA) birthweight.
STUDY DESIGN: This is a secondary analysis of a large prospective
cohort study designed to examine the risk of GDM in women with
NAFLD. Singleton nondiabetic pregnant women were evaluated for
the presence of fatty liver at 10-14 weeks of gestation by abdominal
ultrasound. The degree of fatty liver was classified as normal, mild,
and moderate/severe. LGA was defined as birthweight >90th
percentile for gestational age using data derived from a Korean
population.
RESULTS: A total of 623 women were included in the analysis. The
frequency of LGA was 10.9% (68/623). 18.9% (118/623) had
NAFLD [mild fatty liver 14.4% (90/623) and moderate/severe fatty
liver in 4.5% (28/623)]. The risk of LGA increased significantly in
patients with moderate/severe fatty liver in the first trimester (the
risk of LGA, 10.1% in normal liver echogenicity vs. 8.9% in mild
fatty liver vs. 32.1% in moderate/severe fatty liver, p<0.005)
(Figure). The relationship between moderate/severe fatty liver and
LGA remained significant after adjustment for pre-gestational BMI,
GDM, and maternal serum triglyceride levels (RR 3.228; 95% CI
1.185-8.795).
792 Role of TSIG in maternal Graves’ disease for
prediction of neonatal thyroid dysfunction
Asha Rijhsinghani, Yiwen Cui
Albany Medical Center, Albany, NY
OBJECTIVE: To determine the impact of maternal and fetal thyroid-
stimulating immunoglobulin (TSIG) as predictors of neonatal thy-
roid dysfunction in pregnancies complicated by Graves’ disease.
STUDY DESIGN: This prospective cohort study was conducted at The
University of Iowa Hospital and Clinics. We analyzed all women with
a history of Graves’ disease with confirmed elevated TSIG at the time
they underwent cordocentesis for reasons of suspected fetal thyro-
toxicosis. Indications for cordocentesis included fetal tachycardia,
IUGR, oligohydramnios, hydrops, and thyromegaly. In addition,
neonatal TSIG, thyroid stimulating hormone (TSH) and free T4
levels were obtained at or within 24 hours after delivery. Neonatal
diagnosis of hyper/hypo-thyroidism was made based on neonatal
TSH.
RESULTS: 14 patients with history Graves’ disease were included in
the study (Table 1). 7 patients were being treated for iatrogenic
hypothyroidism at the time of cordocentesis. Based on blood tests,
all were euthyroid with TSH levels < 3.0 mIU/L in the second
trimester. Transfer of maternal TSIG to neonate appear to have a
sigmoidal saturation affect (Figure 1, R2 ¼.69). The TSIG level from
neither the mother nor the neonate corresponded to the diagnosis of
neonatal thyroid dysfunction. However, the number of neonates
with hyperthyroidism from mothers on levothyroxine was twice that
of neonates delivered by mothers on methimazole. All neonates of
the former group additionally required treatment for
hyperthyroidism.
CONCLUSION: While we did not find a correlation between maternal
or fetal TSIG level with neonatal thyroid dysfunction, close moni-
toring of women with a past history of Graves’ disease and currently
on levothyroxine may be warranted as they can have an increased
risk for a fetus affected by hyperthyroidism.

S472 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2018