(387) The Association Between Allostatic Load and Gestational Diabetes -Related Pregnancy Outcomes

To examine the association of allostatic load with gestational diabetes (GDM) and GDM-related pregnancy outcomes.

Study Design:
This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study, which followed nulliparas from early pregnancy to 2-7 years postpartum. The primary exposure of this analysis was high allostatic load (AL) in the first trimester, defined as having four or more of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine, and albumin) being in the highest-risk quartile. The primary outcome was the frequency of GDM in the entire cohort. Secondary outcomes were pregnancy complications among those who developed GDM. Univariable and multivariable logistic regression models were used to evaluate association between AL and adverse pregnancy outcomes.

Results:
A total of 1405 (38%) women had high AL. In unadjusted models, high AL was associated with increased odds of GDM (OR 2.88, 95% CI: 2.08–3.98, Table 1). After adjusting for maternal age at first prenatal visit, pre-pregnancy BMI, education, marital status, poverty, physical activity, chronic hypertension, and polycystic ovarian syndrome, high AL remained to be significantly associated with GDM (aOR 1.66, 95% CI 1.09-2.53). Secondary analyses within the GDM subgroup (n=164) demonstrated higher odds of large for gestational age (OR 3.22, 95% CI: 1.16–8.98) and preeclampsia (OR 2.87, 95% CI: 1.02–8.06) (Table 2). After controlling for first trimester BMI, presence of chronic hypertension, GDM type (A1 vs. A2), marital status, and insurance type, these associations did not persist.

Conclusion:
High allostatic load was independently associated with GDM diagnosis. Within the GDM group, no significant association was found between high AL and incidence of pregnancy complications related to GDM after adjusting for potential confounders.