PP317 - PRE-PREGNANCY BODY MASS INDEX AND GESTATIONAL DIABETES AS DETERMINANTS OF LONG-TERM METABOLIC SYNDROME RISK: A DECISION-MAKING ALGORITHM

PP317

PRE-PREGNANCY BODY MASS INDEX AND GESTATIONAL DIABETES AS DETERMINANTS OF LONG-TERM METABOLIC SYNDROME RISK: A DECISION-MAKING ALGORITHM

B. López Plaza^1,2, A. M. Ramos-Levi^1,2,3, L. del Valle¹, R. Martín O’Connor¹, J. Valerio¹, A. Barabash¹, A. Larrad Sáinz¹, M. A. Rubio Herrera¹, C. Marcuello^1,*, I. Jiménez‒Varas¹, V. Melero¹, P. Matía-Martín^1,2,3, A. L. Calle Pascual^1,2,3

¹Departamento de Endocrinología y Nutrición, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), ²Departamento de Medicina, Facultad de Medicina-Universidad Complutense de Madrid, ³CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain

Rationale: Pregnancy is a critical window of metabolic plasticity, with adaptations that may influence the development of gestational diabetes mellitus (GDM) and future metabolic disorders such as metabolic syndrome (MetS). This study aimed to evaluate the effect of a dietary intervention during pregnancy and to identify determinants of MetS six years postpartum (6y-PP).

Methods: A prospective cohort of 1,715 women was randomized at 12 weeks gestation to a Mediterranean diet intervention or control group for 12 weeks. GDM was diagnosed using IADPSG criteria (75 g OGTT), and MetS at 6y-PP was defined according to harmonized criteria. A predictive decision tree (QUEST algorithm) was developed including age, ethnicity, parity, gestational weight gain, GDM history, pre-pregnancy BMI (pp-BMI), and weight recovery. Intervention was forced as the primary split.

Results: At 6y-PP MetS prevalence was lower in the intervention group (7.3 vs. 10.4%, p=0.034), with a 32% risk reduction (OR=0.68 [0.47–0.97]). GDM (OR=2.96 [2.06–4.26]) and higher pp-BMI (OR=7.91 [5.41–11.57]) were the strongest predictors. After ruling out other risk factors by the decision tree model, women without intervention, pp-BMI ≥25 kg/m², and GDM had the highest predicted risk (40%), whereas those with intervention, pp-BMI <25 kg/m², and age <35 years had the lowest risk (1.5%) (Fig.1). Model accuracy was 91.8%.

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Conclusion: Early dietary intervention during pregnancy confers a sustained protective effect against MetS. Pre-pregnancy BMI and GDM are key modifiable determinants of MetS. The proposed algorithm enables early risk stratification and supports targeted prevention strategies and clinical decision-making. 

Disclosure of Interest: B. López Plaza Grant / Research Support from: Instituto de Salud Carlos III (ISCIII) through the FIS call (PI25/01413). Ministry of Science, Innovation and Universities, Government of Spain, A. Ramos-Levi Grant / Research Support from: Grant / Research Support from: Instituto de Salud Carlos III (ISCIII) through the FIS call (PI25/01413). Ministry of Science, Innovation and Universities, Government of Spain, L. del Valle: None declared, R. Martín O’Connor: None declared, J. Valerio: None declared, A. Barabash: None declared, A. Larrad Sáinz: None declared, M. Rubio Herrera: None declared, C. Marcuello: None declared, I. Jiménez‒Varas Grant / Research Support from: Instituto de Salud Carlos III (ISCIII) through the FIS call (PI25/01413). Ministry of Science, Innovation and Universities, Government of Spain, V. Melero Grant / Research Support from: Instituto de Salud Carlos III (ISCIII) through the FIS call (PI25/01413). Ministry of Science, Innovation and Universities, Government of Spain, P. Matía-Martín: None declared, A. Calle Pascual Grant / Research Support from: Grant / Research Support from: Instituto de Salud Carlos III (ISCIII) through the FIS call (PI25/01413). Ministry of Science, Innovation and Universities, Government of Spain