S14 Abstracts / Can J Diabetes 41 (2017) S2?S16 Rationale: The purpose of this study was to test the hypothesis that obesity-risk in adolescence is elevated in children expose to adverse events, in a dose-response manner. Methods: We performed a prospective analysis of 6942 adolescents and their primary care givers in the Growing Up in Ireland child cohort study with measurements obtained in children at 9 and 13 yrs of age. Main exposures were adverse experiences before 9 yrs including several Adverse Child Experience (ACEs) exposures. Main outcome was Objectively measured overweight and obesity at 13 years of age determined using World Health Organization criteria for age and sex. Confounding included objectively measured parental weight status, self-reported physical activity and diet, household income, gender, and family structure. Results: More than 75% of the youth experienced an adverse experience and 17% experienced an ACE- experience before 9 yrs of age. After adjusting for confounding, exposure to any adverse experience was associated with increased odds of overweight/obesity (aOR: 1.15; 95% CI: 1.00?1.32) and obesity (aOR: 1.35; 95% CI: 1.09? 1.69). These associations were stronger among adolescents living in lower income households and if children were exposed to ACEspeci?c adverse experiences (overweight/obesity- aOR: 1.21; 95% CI: 1.01?1.46; obesity- aOR: 1.50; 95% CI: 1.13?1.98). Conclusions: Childhood adverse experiences, particularly severe adverse experiences, are independently associated with an increased risk of obesity in early adolescence. Increased efforts to assess and address these experiences may improve treatment and prevention efforts for adolescent obesity. 41 Lay- or Expert-Led Interventions for Weight Loss in Overweight Youth, What Works? A Systematic Review and Network Meta-Analysis BHUPENDRASINH F. CHAUHAN, RASHEDA RABBANI, AHMED M. ABOU-SETTA, RYAN ZARYCHANSKI, JONATHAN MCGAVOCK Winnipeg, MB 42 Pregnancy Characteristics and Maternal Risk of Type 2 Diabetes Mellitus CHRISTY WOOLCOTT*, SARAH D. MCDONALD, HUDE QUAN, MOHAMED ABDOLELL, TREVOR DUMMER, LINDA DODDS Halifax, NS Background: Gestational diabetes mellitus (GDM) is known to be associated with an approximately seven-fold increased risk of developing type 2 diabetes mellitus (T2DM) in women. Our objective was to examine other pregnancy characteristics in addition to GDM in relation to T2DM. Methods: A population-based retrospective cohort study was conducted with information about women?s ?rst and subsequent pregnancies from the Nova Scotia Atlee Perinatal Database (1988? 2009) and later T2DM from physician claims and hospital discharge databases (1989?2012). Hazard ratios (HR) with 95% con?dence intervals (CI) adjusted for maternal weight, age at ?rst birth, area-level income, smoking, and other pregnancy characteristics were estimated. Results: Among 78,977 women without pre-existing diabetes and complete data, 2969 (3.8%) developed T2DM over a median 14.8 years of follow-up. GDM was associated with the risk of developing T2DM (HR 7.50, CI 6.90?8.15). Among women with a history of GDM, pregnancy characteristics also associated with the risk of T2DM included any history of: Caesarean section (HR 1.16, CI 1.01?1.34); birthweight for gestational age >90th percentile (HR 1.29, CI 1.11? 1.49); neonatal hypoglycemia (HR 1.40, CI 1.16?1.69); and breastfeeding (HR 0.79, CI 0.69?0.91). These characteristics were similarly associated with T2DM risk among women without a history of GDM; additionally, pre-eclampsia (HR 1.54, CI 1.28?1.84) and gestational hypertension (HR 1.69, CI 1.52?1.87) were associated with T2DM in this group. Conclusions: Pregnancy characteristics are associated with the risk of developing T2DM, including hypertensive disorders of pregnancy among women without a history of GDM. 43 Background: Lay or peer-led approaches are an attractive option for public health interventions however their effectiveness for weight loss among overweight youth remains unclear. We conducted a systematic review and network meta-analysis to address this issue. Methods: We searched MEDLINE, Embase, the Cochrane Library, and CINAHL from January 1, 1996 to May 20, 2016 for randomized clinical trials (RCTs) of behavioural weight loss interventions lasting 12 weeks in youth <18 years and strati?ed into 3 arms:1) lay-led; 2) expert-led; and 3) standard of care. The primary outcomes were change from baseline in weight and body mass index (BMI). Secondary outcomes were BMI-z score, BMI %tile, percent fat, and study withdrawals. Findings: Of 25,586 citations retrieved, 64 RCTs representing 5598 overweight or obese children and adolescents were analyzed (mean age 11.4 years; 40.7% male). Compared to standard weight loss interventions, expert-led interventions yielded signi?cant reductions in weight [median difference (MD) ?2.45 Kg, 95% credible interval (CrI) ?3.69 to ?1.32; 15 RCTs] and BMI [MD ?0.90 Kg/m2, 95% CrI ?1.60 to ?0.28; 14 RCTs]. The magnitude of weight reduction associated with expert-led intervention was maintained even after termination of intervention [MD ?2.50, 95% CrI ?4.40, ?0.83, 6 RCTs]. Layled interventions failed to reach a statistically signi?cant reduction in weight or BMI, compared to control [MD ?0.71 kg, 95% CrI ?3.40, 1.90 and MD ?1.74 kg/m2, 95% CrI ?4.56, 0.96] Interpretation: Expert-led approaches are the most effective for weight reduction among overweight youth. Sparse data on layled weight loss intervention warrants further research. Implementation and Evaluation of the Metformin First Protocol for Management of Gestational Diabetes Mellitus REHA KUMAR, JULIA LOWE, FIONA THOMPSON-HUTCHISON, DAPHNA STEINBERG, ILANA HALPERIN* Toronto, ON Background: In light of growing evidence recommending metformin as ?rst-line drug therapy for gestational diabetes mellitus(GDM), the Diabetes in Pregnancy Clinic at Sunnybrook Hospital implemented the ?Metformin First? protocol. Metformin is now offered to all patients requiring medication for management of GDM. Objectives & Methods: A retrospective chart review was conducted of GDM patients seen at the clinic prior to(Jan-Jul2015) and following(Jan-Sept2016) implementation of the protocol to compare pregnancy outcomes. A prospective patient survey was also administered to evaluate impact on patient satisfaction and clinic e?ciency. Results: 264 patient charts were reviewed: 159 patients (60%) were treated with lifestyle modi?cations, 46(17%) with metformin, 40(15%) with insulin and 19(7%) with metformin+insulin. There were no signi?cant differences in rates of pregnancy complications (obstructed labour, infants born large for gestational age, NICU admissions and infant hypoglycemia) or gestational weight gain. Blood glucose control was also comparable and satisfactory across groups. Of the 65 patients initially started on metformin, 21(32%) were switched to or provided supplemental insulin therapy. However, the overall percentage of patients started on insulin?thus requiring individualized patient training?has decreased signi?cantly(33% in 2015 vs 17% in 2016, p=0.003). Following implementation of the protocol, Abstracts / Can J Diabetes 41 (2017) S2?S16 patient satisfaction scores at the clinic have also increased(4.68/5 in 2016 vs 4.3/5 in 2013, p=0.01). Conclusions: Metformin is comparable to insulin in glycemic control and pregnancy outcomes for management of GDM. Introduction of this protocol has resulted in improved patient satisfaction and clinic e?ciency. 44 ? Conjoint Associations of Gestational Diabetes and Hypertension with Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study ROMINA PACE*, ANNE SOPHIE BRAZEAU, SARA MELTZER, ELHAM RAHME, KABERI DASGUPTA Montreal, QC Background: The conjoint association of gestational diabetes (GDM) and gestational hypertension (GH) with cardiometabolic disease has not been well studied. Objective: To evaluate combined GDM/GH risk indicator in both mothers and in fathers given shared spousal behaviours and environments. Methods: In this population-based retrospective cohort study, GH was identi?ed in matched pairs (GDM vs. no GDM, matched on age group, health region, year of delivery) of mothers with singleton live births (Quebec, Canada; 1990?2007). 64,232 couples were categorized based on GDM/GH status (?neither?; ?either?; or ?both?). Associations with diabetes, hypertension, and cardiovascular disease (CVD) and mortality composite were evaluated (12 weeks postpartum to March 2012; Cox proportional hazard models). Results: Compared to the ?neither? category, having ?either? GDM or GH was associated with incident diabetes (HR:14.7, 95% CI: 12.9, 16.6), hypertension (HR:1.9, 95% CI:1.8, 2.0), and CVD and mortality (HR:1.9, 95%CI:1.5, 2.4). Having ?both? demonstrated associations of greater magnitude (diabetes: HR:36.9, 95%CI:26.0,52.3; hypertension HR:5.7, 95%CI:4.9,6.7; CVD HR: 3.5, 95%CI:2.0, 6.0). Associations with diabetes were also observed in fathers (either HR:1.2,9 5%CI 1.1, 1.3; both HR1.8, 95%CI:1.4, 2.3;). Conclusions: A combined GDM/GH indicator demonstrates associations with cardiometabolic disease in mothers and diabetes in fathers, with stronger associations when both GDM and GH occur. 45 Early Diabetes Screening, Before Hospital Discharge, in Postpartum Women with Gestational Diabetes: A New Validated Method JEAN-LUC ARDILOUZE, GARRY X. SHEN, LORRAINE LIPSCOMBE, ILANA HALPERIN, ELIZABETH SALAMON, SORA LUDWIG, VINCENT WOO, JULIE MENARD, ANNIE OUELLET, MARIE-HELENE PESANT, MARIE-FRANCE HIVERT, JEAN-PATRICE BAILLARGEON Sherbrooke, QC Rationale: Diabetes screening with an oral glucose tolerance test (OGTT) is recommended 6?24 weeks after gestational diabetes (GD). However, screening rates are low. We hypothesized that an OGTT, performed before hospital discharge, can identify women with higher risk of glucose intolerance. Objectives: 1) To determine and validate the optimal 2-hour plasma glucose (2-hPG) threshold value before hospital discharge (OGTT-1) that rules out glucose intolerance at 6?24 weeks (OGTT-2); 2) to assess women?s preferred time for testing. Methods: Prospective multicenter cohort study of women with GD who performed both OGTTs and were randomly allocated to the determination (n=110) or validation (n=220) cohort. A satisfaction questionnaire was completed after each OGTT. ROC curves were used to determine OGTT-1 2-hPG thresholds, using OGTT-2 as the reference standard. S15 Results: Determination and validation cohorts had similar age (32.2�4/31.5�1 years), BMI (28.9�0/29.0�4 kg/m2), ethnicity (78.2/78.2% Caucasian), OGTT values and timing. In the determination cohort, the optimal 2-hPG cut-off value was 8.0 mmol/L. In the validation cohort, only 3.6% of the 53% who were below this cut-off had glucose intolerance on OGTT-2. Sensitivity was 84.0%, speci?city 57.9%, positive predictive value (PV) 20.4%, negative PV 96.6%. Most women (81%) preferred the early test. Conclusion: An OGTT before hospital discharge accurately rules out glucose intolerance in half of postpartum GD patients, eliminating the need for later testing. A 2-hPG threshold of 8.0 mmol/L identi?es higher-risk women who may bene?t from targeted interventions. 46 Moms in Motion-Social Media-Assisted Prenatal Education Program Increases Participation of Pregnant Women in Prenatal Education in Manitoba First Nations Communities AMY HUI, BRANDY WICKLOW, ELIZABETH SELLERS, JON MCGAVOCK, NATHAN NICKEL, SORA LUDWIG, MARGARET MORRIS, LARRY WOOD, WANDA PHILIPS-BECK, RHONDA CAMPBELL, FRANCES DESJARLAIS, GLORIA MUNROE, MAXINE ROULETTE, DOLORIS BEAULIEU, CONNIE KUZDAK Winnipeg, MB Previous studies have demonstrated that First Nations (FN) pregnant women urgently need feasible and culturally appropriate prenatal education. However, the prenatal class attendance rate is low in many FN communities, or the program is not active in some communities. Socioeconomic and geographic barriers have been identi?ed as major underlying mechanism for the low access to prenatal education in rural-living FN pregnant women in Manitoba. Access to the internet and Facebook is widespread. We developed a Facebook-linked website, www.momsinmotion.ca, to deliver prenatal and breastfeeding in the communities. The content includes video/audio education on healthy eating, physical activity, diabetes/ obesity prevention and breastfeeding promotion. The website was advertised through community radio/TV station and workshops in 3 FN communities. Pregnant women in the communities can sign up through internet to access the information 81/220 of pregnant women signed up for the e-education from the 3 FN communities from July, 2015 to December, 2016, which represented 37% of total pregnancies in the 3 FN communities. The prenatal education delivery rate was increased by 3 times (p<0.001) compared to that in 2011-13 in those communities (12%). Preterm birth and microsomia and macrosomia were reduced in the communities by 32%, 37% and 5% after the launch of e-education compared to that before, but the differences were not statistically different. In conclusion, e-education increases the participation of prenatal education of ruralliving FN pregnant women and potentially improves neonatal outcomes in the communities. Supported by the Lawson Foundation. 47 Perception of Stigma is Associated with Poor Diabetes Control Among Adolescents and Young Adults with Type 1 Diabetes ANNE-SOPHIE BRAZEAU, MICHAEL WRIGHT, MERANDA NAKHLA, MELANIE HENDERSON, CONSTADINA PANAGIOTOPOULOS, DANIELE PACAUD, ELHAM RAHME, DEBORAH DA COSTA, KABERI DASGUPTA Montreal, QC Aim: Stigma related to chronic disease is rejection, judgement, or exclusion related to the chronic disease itself. We aim to determine the prevalence of stigma among youth and young adults with type 1 diabetes (T1D) in Canada and its association with diabetes control.