Objective Diabetes and frailty pose a significant issue for society. Previous research has shown a mixed relationship between diabetes and frailty in older people, indicating a complex interrelationship. The aim of this study was to examine the association between routinely collected HbA1c testing data and frailty in a large cohort from Western Sydney.Methods Data from the Western Sydney Frailty Registry Study were linked to the Blacktown and Mount Druitt hospital HbA1c testing datasets. These datasets include information on patient outcomes, pathological metrics, hospitalisation indicators, and a range of morbidity and demographic information. This was then analysed in Stata using multivariable regression.Results Diabetes was more common in frail patients than in pre-frail or non-frail patients. Those with both diabetes and frailty did not have an increased risk of death or rehospitalisation in age and sex corrected analyses (OR: 0.66, 95% CI: 0.36-1.21 and 0.90, 95% CI: 0.37-2.17, respectively) compared to those with frailty alone. There was a reduced risk of death associated with higher HbA1c for frail people (OR: 0.58, 95% CI: 0.37-0.90).Conclusions There is a complex interrelationship between diabetes and frailty. For frail people with diabetes, there are important lessons for management. These include the possibility that HbA1c is not a useful metric and that overtreatment with hypoglycaemic agents must be considered.

Introduction and Objective: The 2025 ADA standards recognize early pregnancy dysglycemia is associated with worse outcomes, and recommend detection with either fasting glucose (FG) or A1C. This study compared different early glycemic screening strategies for overt diabetes (ODIP) and GDM prediction. Methods: Pregnant women with GDM risk factors enrolled in a multicenter early GDM RCT had a 75g OGTT and A1C <20 wks using ADA ODIP and GDM criteria. Repeat OGTT occurred at 24-28 wks if untreated (normal OGTT and randomized 50% early GDM). Area under the receiver operator curve (AUROC) with 95%CI was used for ODIP and late GDM prediction. The proportion of late OGTTs avoided included those with an A1C or FG <90% sensitivity thresholds or reaching the ADA early screening thresholds (A1C≥5.9%; FG≥110 mg/dL). Results: Among 3515 women, mean age was 31±5 yrs, BMI 29.9±7.4 kg/m2, OGTT gestation 16±3 wks, 40.6% were European. A1C and FG had similar AUROCs for ODIP and similar, but lower, AUROCs for GDM. The ADA-recommended A1C and FG thresholds were<50% sensitive for ODIP and <5% sensitive for GDM. An early FG threshold of 92 mg/dL was <70% sensitive for ODIP and persistent GDM. An early A1C threshold of 4.8% or FG of 76 mg/dL (@90% sensitivity for GDM) could avoid 22.7% of 24-28 week OGTTs (Table 1). Conclusion: The 2025 ADA recommended early pregnancy A1C and FG thresholds are insensitive tests for detecting women with ODIP and later pregnancy GDM. D. Simmons: Research Support; Novo Nordisk, AMSL. Other Relationship; Abbott, Abbott, Boehringer-Ingelheim. Speaker's Bureau; Ascensia Diabetes Care. C.J. Nolan: None. J. Immanuel: None. H. Teede: None. J.R. Flack: None. V.W.M. Wong: None. E. Hibbert: None. M. McLean: Advisory Panel; Recordati Rare Diseases. A. Kautzky-Willer: None. J. Harreiter: None. H.E. Backman: None. E.J. Gianatti: None. A. Sweeting: None. V. Mohan: Speaker's Bureau; Novo Nordisk. Advisory Panel; Abbott. Research Support; Servier Laboratories. Speaker's Bureau; USV Private Limited, Sanofi, Medtronic, Eli Lilly and Company. W. Hague: None. NHMRC (grants 1104231 and 2009326); Region ?rebro Research Committee Dnr OLL-970566, OLL-942177; Medical Scientific Fund of the Mayor of Vienna, project 15205; South Western Sydney Local Health District Academic Unit grant 2016; Western Sydney University Ainsworth Trust grant 2019

OBJECTIVE:Pituitary tumors are a heterogeneous group of neoplasms exhibiting a wide range of clinical and histological features. There are currently no comprehensive clinically validated prognostic tools to guide management of all tumor types before and after surgery. Recently, the PANOMEN 3 classification, incorporating risk factors for disease severity, was proposed as a potential grading system to assess prognosis. We aimed to evaluate the clinical utility and application of the new PANOMEN 3 classification. DESIGN AND METHODS:We conducted a retrospective study of 215 cases of pituitary tumors surgically resected at Westmead Hospital between 2011 and 2018. All tumors were histologically examined according to the 2022 WHO Classification of pituitary tumors. Preoperative and postoperative PANOMEN 3 grades were assigned, and recurrence analyses performed. Results were compared to the French clinicopathological classification. RESULTS:Compared to PANOMEN 3 grade 0, risk of recurrence was highest for grade 3 (HR 10.99; 95% CI 1.14-106.11, P = .038), followed by grade 2 (HR 7.85; 95% CI 1.06-58.31, P = .044), but not significantly different for grade 1. Proportions of tumors needing further intervention was greater with higher PANOMEN 3 grades; interventions occurred earlier in high grade tumors. The French classification remained a significant predictor of recurrence when adjusted for PANOMEN 3 (P < .001), but PANOMEN 3 was not a strong predictor when adjusted for French classification (P = .374). CONCLUSIONS:In the postoperative setting, PANOMEN 3 classification is useful in prediction of recurrence and need for further therapy. However, it was a weaker tool for predicting recurrence than the French classification.

OBJECTIVE:To compare the prevalence and clinical characteristics of early gestational diabetes (eGDM) and associated birth outcomes among women of different ethnic groups. METHODS:This is a secondary analysis of an international, multicenter randomized controlled trial of treating eGDM among pregnant women with GDM risk factors enrolled at < 20 weeks' gestation. GDM diagnosis was made using WHO-2013 criteria. Ethnicity was classified by self-identification. While Europids required at least one risk factor for recruitment, for others, ethnicity itself was a risk factor. RESULTS:Among women of Europid (n = 1567), South Asian (SA: n = 971), East and South-East Asian (ESEA: n = 498), Middle Eastern (ME: n = 242), and Māori and Pasifika (MP: n = 174) ethnicities; MP (26.4%) had the highest eGDM crude prevalence compared with Europid (20.3%), SA (24.7%), ESEA (22.3%), and ME (21.1%) (P < .001). Compared with Europid, the highest eGDM adjusted odds ratio (aOR) was seen in SA (2.43 [95% CI 1.9-3.11]) and ESEA (aOR 2.28 [95% CI 1.68-3.08]); in late GDM, SA had the highest prevalence (20.4%: aOR 2.16 [95% CI 1.61-2.9]). Glucose patterns varied between ethnic groups and ESEA were predominantly diagnosed with eGDM through post-glucose load values, while all other ethnic groups were mainly diagnosed on fasting glucose values. There were no differences in the eGDM composite primary outcome or neonatal and pregnancy-related hypertension outcomes between the ethnic groups. CONCLUSION:In women with risk factors, eGDM was most prevalent in SA and ESEA women, particularly identified by the post-glucose load samples. These findings suggest an early oral glucose tolerance test should particularly be performed in women from these ethnic groups.

Introduction: The demographic shift amongst pregnant women, including older age and increasing obesity, has resulted in an increased risk of cardiometabolic complications during pregnancy, particularly gestational diabetes. This paper presents physical activity and gestational diabetes data in a multi-ethnic urban Australian population. Methods and analysis: The PROMOTE cohort study is an ongoing prospective pregnancy cohort study recruiting pregnant participants < 16 weeks gestation at a large urban public teaching hospital with high social and cultural diversity in Sydney, Australia. Participants are surveyed about their physical activity levels, dietary quality, emotional wellbeing and socio-demographic status using validated tools. Participants are consented for use of routinely collected clinical and social data, including medical conditions, body mass index (BMI), blood pressure (BP) and glycaemia. Follow-up is from routinely collected data. Results: A total of 459 participants were recruited between February 2022 and February 2024. Physical activity levels at recruitment were sufficiently active, low active and inactive in 39%, 45% and 16% of participants. Participation in moderate or vigorous physical activity was reported in 19% and 16% of participants, respectively. Participation in vigorous physical activity occurred in 10% of those with GDM vs. 17% of those without GDM (p = 0.11). Participation in any moderate/vigorous physical activity was reported in 20% of those with GDM vs. 30% of those without GDM (p = 0.058). Compared to inactive behaviour, the unadjusted odds ratio of developing GDM amongst those participating in any moderate/vigorous physical activity was 0.58 (95% CI 0.33–0.97), p = 0.045. Participation in any moderate/vigorous physical activity showed an association with lower oral glucose tolerance test levels at 1 h (7.49 vs. 8.17 mmol/L, p = 0.002). Participation in any vigorous activity was associated with lower oral glucose tolerance test levels at 1 h (7.25 vs. 8.11, p = <0.001). Conclusions: Uptake of existing physical activity recommendations is low. Gestational diabetes risk showed a trend toward variation by intensity of physical activity, with a trend toward greater intensity being associated with a possible lower rate of gestational diabetes.

Objective: To investigate the association of timing of commencing glucose management with glycemia, glycemic variability, and pregnancy outcomes among women with early gestational diabetes mellitus (GDM). Research Design and Methods: A sub-study among participants of a trial of immediate vs delayed treatment of early GDM diagnosed by WHO-2013 criteria. All women treated immediately and those with delayed diagnosis at 24-28 weeks’ (treated as if late GDM) were instructed to monitor capillary blood glucose (BG) 4 times/day (fasting and 2-h post-prandial) until delivery. Optimal glycemia was defined as ≥95% of BG measurements between 70-140mg/dl (3.9-7.8mmol/l). Results: Overall, 107,716 BG values were obtained from 329/549 (59.9%) women (mean age 32.3±4.9years, BMI 32.0±8.0kg/m2, 35% European, gestation at GDM diagnosis 15.2±2.4weeks’). Women treated early (n=213) showed lower mean glucose (MG) and mean fasting glucose (MFG) compared with those treated late (n=116) (MG:5.7±0.4 vs. 5.9±0.5, p<0.001, MFG:5.2±0.3 vs. 5.3±0.4, p=0.004) with greater optimal glycemia (74.6% vs. 59.5%, p=0.006) and similar glycemic variability. The MG was similar from 30 weeks’ gestation. Overall, optimal glycemia was achieved in 69% of women and associated with lower birthweight, decreased large-for-gestational-age infants (14.4% vs. 26.7%, p=0.01) along with increased small-for-gestational-age infants (15.3% vs. 5.9%, p=0.02) and lower gestational weight gain (4.9±6.4 vs. 7.6±6.2kg, p=0.001). Suboptimal glycemia was associated with non-European ethnicity, prior GDM, 1-hour glucose at booking oral glucose tolerance test, and insulin use. Conclusions: Both early and delayed treatment of early GDM resulted in similar glycemia toward the end of pregnancy; early treatment was associated with improved glycemia overall.

The International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria for gestational diabetes (GDM) were widely implemented in Australia, despite limited evidence of better pregnancy outcomes compared to the Australasian Diabetes in Pregnancy Society 1998 (ADIPS1998) criteria. We aimed to evaluate the effect of treatment on pregnancy outcomes for women with ‘mild’ GDM, defined as GDM diagnosed by one, but not both, sets of criteria. This multicentre, retrospective cohort study included 17,512 pregnant women in six neighbouring tertiary hospitals in Sydney, Australia, during 2016–2017, all of whom were screened for GDM using a three-point 75 g oral glucose tolerance test. Three hospitals diagnosed and treated GDM according to ADIPS1998 criteria, and three according to IADPSG criteria. For women with ‘mild’ GDM, we evaluated the effect of treatment versus no treatment on pregnancy outcomes. The primary outcome was large for gestational age. Secondary outcomes were small for gestational age, induction of labour, caesarean section, gestational hypertension, and preeclampsia. 2320 (13.2

INTRODUCTION:The PROMOTE cohort study is a prospective pregnancy cohort study that seeks to improve the understanding of cardiometabolic risk and determinants, such as diet, during pregnancy in a multi-ethnic population. Increasing age and obesity has resulted in an increased risk of cardiometabolic complications during pregnancy, including gestational diabetes. Trials of lifestyle interventions have so far produced mixed results, partly due to a wide variation in the methods, duration, adherence and type of dietary intervention. There is a need for high quality data about dietary habits in pregnancy, particularly in multi-ethnic populations. OBJECTIVES:In this study, we report the dietary habits of women in early pregnancy in the population of interest. We report early data seeking to assess the relationship between dietary patterns and risks of gestational diabetes. METHODS AND ANALYSIS:The PROMOTE cohort study is a prospective pregnancy cohort study recruiting pregnant participants with <16 weeks gestation in an area of high social and cultural diversity in western Sydney, Australia. The participants are surveyed about their physical activity levels, diet quality, emotional wellbeing and sociodemographic status using validated tools. Participants have consented to the use of routinely collected clinical and social data, including medical conditions, body mass index (BMI), blood pressure (BP) and glycaemia. The follow-up is from routinely collected data. This paper presents dietary data. RESULTS:A total of 459 participants were recruited (n = 459), including 416 with GDM data available, at the conclusion of the first 2 years of recruitment. No participants met national dietary guideline recommendations. Fifty-six participants (n = 56, 13%) met a pragmatic composite standard of favourable diet, defined as two servings of vegetables and two servings of fruit per day, with a maximum of one discretionary serving per day. Over half the participants (n = 215, 51%) reported an adequate daily fruit intake. In total, 7 participants ate at least five servings of vegetables per day (n = 7, 1.7%), 61 participants (14.7%) ate three or more servings of vegetables per day and 212 (51.2%) participants reported one discretionary item per day. The data suggest that few women meet dietary recommendations in pregnancy. The association between dietary habits and GDM was unable to be assessed. The study was underpowered to detect an association due to the highly skewed distribution of dietary patterns in our population. Conclusions: The uptake of dietary recommendations was very low in our sample. This represents a major population health concern. Multi-level approaches are urgently needed to address poor dietary habits in pregnancy.

OBJECTIVE We evaluated associations between early-pregnancy oral glucose tolerance test (OGTT) glucose and complications in the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) cohort to inform prognostic OGTT thresholds. RESEARCH DESIGN AND METHODS Individuals with risk factors for hyperglycemia were recruited for an international, multicenter, randomized controlled gestational diabetes mellitus (GDM) (World Health Organization 2013 criteria) treatment trial. A 2-h 75-g OGTT was performed at <20 weeks’ gestation. Individuals with early treated hyperglycemia in pregnancy were excluded from the primary analysis. Early OGTT glucose concentrations were analyzed continuously and in glycemic categories (normal, low band, and high band). RESULTS Overall, 3,645 individuals had an OGTT at (mean ± SD) 15.6 ± 2.5 weeks. For each 1-SD increase in fasting, 1-h, and 2-h glucose values, there were continuous positive associations with late GDM: adjusted odds ratio (aOR) 2.04 (95% CI 1.82–2.27), 3.05 (2.72–3.43), and 2.21 (1.99–2.45), respectively. There were continuous positive associations between 1-h and 2-h glucose and the perinatal composite (birth <37 + 0 weeks, birth trauma, birth weight ≥4,500 g, respiratory distress, phototherapy requirement, stillbirth/neonatal death, and shoulder dystocia), with aOR 1.15 (95% CI 1.04–1.26) and 1.14 (1.04–1.25), respectively, and with large-for-gestational-age offspring, with aOR 1.18 (1.06–1.31) and 1.26 (1.01–1.25), respectively. Significant associations were also observed between 1-h glucose and cesarean section and between fasting and 2-h glucose and neonatal hypoglycemia. In categorical analysis, only the high-band 1-h glucose (≥10.6 mmol/L [191 mg/dL]) predicted the perinatal composite. CONCLUSIONS There is a continuous positive association between early-pregnancy OGTT glucose and complications. In individuals with hyperglycemia risk factors, only the high-glycemic-band 1-h glucose corresponded to increased risk of major perinatal complications.

Aim: To evaluate the incidence and predictors of postpartum dysglycaemia among high-risk women who develop early gestational diabetes (eGDM) prior to 20 weeks' gestation. Methods: This is a sub-study of the Treatment of Booking Gestational Diabetes (TOBOGM) Study, a randomised controlled trial of early or deferred treatment for women with risk factors for gestational diabetes diagnosed with eGDM, using current WHO criteria. Overt diabetes in pregnancy was excluded. A repeat oral glucose tolerance test (oGTT) was recommended at 6-12 weeks postpartum. Results: Of 793 participants, 352 (44.4%) underwent a postpartum oGTT. Baseline characteristics of participants with and without an oGTT were similar. Ninety-two (26.1%) had postpartum dysglycaemia: 11 (3.1%) diabetes, 31 (8.8%) impaired fasting glucose (IFG), 39 (11.1%) impaired glucose tolerance (IGT), and 11 (3.1%) combined IFG/IGT. Participants with postpartum dysglycaemia were more likely to have had past GDM, lower body mass index, more gestational weight gain, and higher 1 and 2-hour glucose concentrations on the early pregnancy oGTT. On logistic regression, higher 1 and 2-hour glucose concentration, previous GDM and greater gestational weight gain were independently associated with postpartum dysglycaemia. Conclusion: There is a high incidence of postpartum dysglycaemia among high-risk women with eGDM.

OBJECTIVE To compare pregnancy outcomes among women with a normal oral glucose tolerance test (OGTT) before 20 weeks' gestation (early) and at 24-28 weeks' gestation (late) (no gestational diabetes mellitus, or No-GDM), those with early GDM randomized to observation with a subsequent normal OGTT (GDM-Regression), and those with GDM on both occasions (GDM-Maintained). RESEARCH DESIGN AND METHODS Women at <20 weeks' gestation with GDM risk factors who were recruited for a randomized controlled early GDM treatment trial were included. Women with treated early GDM and late GDM (according to the World Health Organization's 2013 criteria) were excluded from this analysis. Logistic regression compared pregnancy outcomes. RESULTS GDM-Regression (n = 121) group risk factor profiles and OGTT results generally fell between the No-GDM (n = 2,218) and GDM-Maintained (n = 254) groups, with adjusted incidences of pregnancy complications similar between the GDM-Regression and No-GDM groups. CONCLUSIONS Women with early GDM but normal OGTT at 24-28 weeks' gestation had pregnancy outcomes that were similar to those of individuals without GDM. Identifying early GDM likely to regress would allow treatment to be avoided.

Objective: To identify factors associated with neonatal respiratory distress (NRD) in early Gestational diabetes mellitus (eGDM). Design: Nested case-control analysis of the TOBOGM trial. Setting: Seventeen hospitals: Australia, Sweden, Austria and India. Population: Pregnant women, <20 weeks' gestation, singleton, GDM risk factors. Methods: Women with GDM risk factors completed an oral glucose tolerance test (OGTT) before 20 weeks: those with eGDM (WHO-2013 criteria) were randomised to immediate or deferred GDM treatment. Logistic regression compared pregnancies with/without NRD, and in pregnancies with NRD, those with/without high-dependency nursery admission for <= 24 h with those admitted for >24 h. Comparisons were adjusted for age, pre-pregnancy body mass index, ethnicity, smoking, primigravity, education and site. Adjusted odds ratios (95% CI) are reported. Main Outcome Measures: NRD definition: >= 4 h of respiratory support (supplemental oxygen or supported ventilation) postpartum. Respiratory distress syndrome (RDS): Supported ventilation and >= 24 h nursery stay. Results: Ninety-nine (12.5%) of 793 infants had NRD; incidence halved (0.50, 0.31-0.79) if GDM treatment was started early. NRD was associated with Caesarean section (2.31, 1.42-3.76), large for gestational age (LGA) (1.83, 1.09-3.08) and shorter gestation (0.95, 0.93-0.97 per day longer). Among NRD infants, >24 h nursery-stay was associated with higher OGTT 1-h glucose (1.38, 1.08-1.76 per mmol/L). Fifteen (2.0%) infants had RDS. Conclusions: Identifying and treating eGDM reduces NRD risk. NRD is more likely with Caesarean section, LGA and shorter gestation. Further studies are needed to understand the mechanisms behind this eGDM complication and any long-term effects.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background A recently undertaken multicenter randomized controlled trial (RCT) " Treatment Of BOoking Gestational diabetes Mellitus" " (TOBOGM: 2017-2022) - 2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost-effectiveness of diagnosis and treatment of early GDM (from <20 weeks') ' ) among women with risk factors for hyperglycemia in pregnancy compared with usual care (no treatment until 24-28 - 28 weeks') ' ) from a healthcare perspective. Methods Participants' ' healthcare resource utilization data were collected from their self-reported questionnaires and hospital records, and valued using the unit costs obtained from standard Australian national sources. Costs were reported in US dollars ($) using the purchasing power parity (PPP) estimates to facilitate comparison of costs across countries. Intention-to-treat (ITT) principle was followed. Missing cost data were replaced using multiple imputations. Bootstrapping method was used to estimate the uncertainty around mean cost difference and costeffectiveness results. Bootstrapped cost-effect - effect pairs were used to plot the cost-effectiveness (CE) plane and costeffectiveness acceptability curve (CEAC). Findings Diagnosis and treatment of early GDM was more effective and tended to be less costly, i.e., dominant (cost- saving) [-5.6% - 5.6% composite adverse pregnancy outcome (95% CI: - 10.1%, - 1.2%), - $1373 (95% CI: - $3,749, $642)] compared with usual care. Our fi ndings were confirmed fi rmed by both the CE plane (88% of the bootstrapped cost-effect - effect pairs fall in the south-west quadrant), and CEAC (the probability of the intervention being cost-effective ranged from 84% at a willingness-to-pay (WTP) threshold value of $10,000-99% - 99% at a WTP threshold value of $100,000 per composite adverse pregnancy outcome prevented). Sub-group analyses demonstrated that diagnosis and treatment of early GDM among women in the higher glycemic range (fasting blood glucose 95-109 - 109 mg/dl [5.3-6.0 - 6.0 mmol/ L], 1-h blood glucose >= 191 mg/dl [10.6 mmol/L] and/or 2-h blood glucose 162-199 - 199 mg/dl [9.0-11.0 - 11.0 mmol/L]) was more effective and less costly (dominant) [-7.8% - 7.8% composite adverse pregnancy outcome (95% CI: - 14.6%, - 0.9%), - $2795 (95% CI: - $6,638, - $533)]; the intervention was more effective and tended to be less costly [-8.9% - 8.9% composite adverse pregnancy outcome (95% CI: - 15.1%, - 2.6%), - $5548 (95% CI: - $16,740, $1547)] among women diagnosed before 14 weeks' ' gestation as well. Interpretation Our fi ndings highlight the potential health and economic benefits fi ts from the diagnosis and treatment of early GDM among women with risk factors for hyperglycemia in pregnancy and supports its implementation. Long- term follow-up studies are recommended as a key future area of research to assess the potential long-term health benefits fi ts and economic consequences of the intervention.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Gestational diabetes (GDM) is associated with a long-term risk of diabetes. We aimed to determine whether a text-messaging-based lifestyle support program would improve diabetes risk factors following GDM. Women with GDM were randomised following delivery to receive four text messages per week supporting a healthy lifestyle and parenting for 6 months, with feedback from an activity monitor (intervention), or to receive the activity monitor only (control). The primary outcome was a composite of weight, physical activity and dietary goals. There were 177 women randomised, with 88 intervention and 89 control participants. All the participants experienced COVID-19 lockdowns during the study. Six-month primary outcome data were obtained for 57 intervention participants and 56 controls. There were 7/57 (12%) intervention and 6/56 (11%) control participants who met the primary outcome (relative risk, 1.08; 95%CI, 0.63–1.85; p = 0.79). Two intervention participants met the dietary goals compared to none of the control participants (p = NS). The intervention participants were more likely to record >1000 steps/day (on 102 ± 59 vs. 81 ± 59 days, p = 0.03). When analysed monthly, this was not initially different but became significant 3–6 months post-partum. Interviews and surveys indicated that with the Intervention, healthier choices were made, but these were negatively impacted by COVID-19 restrictions. Participants found the messages motivational (74%) and the activity monitor useful (71%). In conclusion, no improvement in the diabetes risk factors occurred among the women receiving the text messaging intervention when affected by COVID-19 restrictions.

Objective Most gestational diabetes mellitus (GDM) studies have combined women whether or not hyperglycemia was present earlier in pregnancy. This study compared perinatal outcomes between women with early GDM (EGDM: diagnosed <20 weeks’, but untreated until 24-28 weeks’ if GDM still present), late GDM (LGDM: present only at 24-28 weeks’), and normoglycemia at 24-28 weeks’ (controls). Research Design and Methods This is a secondary analysis of a randomized controlled treatment trial of early GDM (defined using WHO 2013 criteria) among women with risk factors <20 weeks’ gestation. Those receiving early GDM treatment were excluded. GDM was treated if present at 24-28 weeks’. The primary outcome was a composite of birth <37+0 weeks’, birthweight≥4500g, birth trauma, neonatal respiratory distress, phototherapy, stillbirth/neonatal death and/or shoulder dystocia. Comparisons were adjusted for age, ethnicity, body mass index (BMI), site, smoking, primigravity and education. Results Women with EGDM (n=254) and LGDM (n=467) had shorter pregnancy duration than controls (n=2339). BMI was lowest with LGDM. The composite was increased with EGDM (OR 1.59, 95%CI 1.18-2.12)) but not LGDM (OR 1.19, 95%CI 0.94-1.50)). Induction of labor was higher in both GDM groups. EGDM (but not LGDM) had higher birth centile, preterm birth rate and neonatal jaundice compared to controls. The greatest need for insulin and/or metformin was with EGDM. Conclusions Adverse perinatal outcomes were increased with EGDM despite treatment from 24-28 weeks’, suggesting the need to initiate treatment early, and more aggressively, to reduce the effects of exposure to the more severe maternal hyperglycemia from early pregnancy.