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1 (ENPP1) expression in adipose tissue of women with excessive versus normal gestational weight gain during pregnancy Aaron Poole, Gayle Olson, Batbayar Tumurbaatar, Kathleen Vincent, Yongquan Jiang, Massoud Motamedi, Gracie Vargas, Manisha Chandalia, Abate Nicola University of Texas Medical Branch Galveston, Obstetrics & Gynecology, Galveston, TX, University of Texas Medical Branch Galveston, Internal Medicine–Endocrinology, Galveston, TX, University of Texas Medical Branch Galveston, Center for Biomedical Engineering, Galveston, TX OBJECTIVE: ENPP1, a transmembrane glycoprotein, has been shown to modulate adipocyte maturation and insulin receptor signaling. These effects have been associated with systemic insulin resistance and increased risk for type 2 diabetes. Our objective is to measure adipocyte ENPP1 expression in response to gestational weight gain (GWG). STUDY DESIGN: Women scheduled for elective repeat cesarean at term and who fasted at least 6 hours were recruited. Blood was obtained before the initiation of intravenous fluids and subcutaneous fat was biopsied after the skin incision. Adipose cell size was analyzed using 3D multi-photon imaging. Tissue expression level of ENPP1 and phosphorylation of Akt (pAkt) for insulin signaling were measured by Western Blot. Using IOM guidelines, excessive vs normal GWG were compared. Statistical Analysis Software was utilized. RESULTS: Fifteen subjects with excessive GWG were compared to 9 with normal GWG. Maternal age, EGA at delivery and pregestational body mass index (BMI) were not significantly different. Delivery BMI, birthweight, tissue expression level of ENPP1, adipocyte cell size and phosphorylated Akt were significantly different (Table). CONCLUSION: Increased expression level of ENPP1 in women with excessive GWG is associated with decreased adipocyte cell size and phosphorylation of Akt, indicating impaired maturation of adipocytes and insulin signaling. These findings suggest women with excessive GWG may be at risk for future systemic insulin resistance and type 2 diabetes. Sample characteristics–Estimated preterm birth prevalences by subgroup