insulin minus insulin at booking) compared to 29% of controls (p¼0.02). There was no difference between the two groups in leptin concentrations in early pregnancy, at 28 weeks or in cord blood at delivery. There was no difference between those who did or did not receive low GI advice with respect to either TNF- a or IL-6 in early pregnancy, at 28 weeks or in cord blood. CONCLUSION: A low GI diet in pregnancy has little effect on leptin and markers of inflammation in a cohort of euglycemic women at risk of macrosomia. We did however note a tendency toward a lower rise in insulin concentrations with advancing gestation in those who received the low GI advice; this warrants further interrogation in a group at risk of gestational diabetes. 341 Identification of those most likely to benefit from a low glycaemic index dietary intervention in pregnancy Jennifer Walsh 1 , Ciara McGowan 1 , Rhona Mahony 1 , Michael Foley 1 , Fionnuala McAuliffe 1 1 University College Dublin, National Maternity Hospital, UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: The ROLO study was a randomised control trial of low glycaemic index (GI) diet in pregnancy for prevention of recurrence of fetal macrosomia. The primary objective of this analysis was to identify which women are most likely to respond to low GI diet in pregnancy to reduce birthweight. The secondary objectives were to identify which features are associated with less glucose intolerance and gestational weight gain (GWG). STUDY DESIGN: All women who received the low GI dietary advice were included. In early pregnancy all had mid-upper arm circum- ference and body mass index (BMI) calculated. Concentrations of glucose, insulin and leptin were measured in early pregnancy and at 28 weeks. At delivery birthweight was recorded and fetal glucose, C- peptide and leptin measured in cord blood. Outcomes for the following groups were compared: those who did or did not have a recurrence of macrosomia; those who did or did not exceed GWG guidelines; and those who did or did not develop glucose intolerance. RESULTS: Women who went on to deliver a second macrosomic infant were taller with a higher mean education level. Those who exceeded GWG guidelines were heavier in their first and second pregnancies,with no difference in maternal height. They also had larger mid-upper arm circumferences. Those who at 28 weeks gestation had glucose intolerance had higher BMI’ s and higher glucose concentrations in early pregnancy with more insulin resis- tance. For each analysis women who responded to the intervention had lower early pregnancy leptin concentrations than those who did not. CONCLUSION: These findings suggest that the maternal metabolic environment in early pregnancy determines later risks of excessive weight gain and metabolic disturbance whereas birthweight is mediated more by genetic factors such as maternal height. Maternal leptin may be a more sensitive marker than maternal BMI, adiposity or insulin resistance of an underlying predisposition to pregnancy complications. 342 A novel pattern of kidney injury in preeclampsia utilizing urinary biomarkers Sarah Rae Easter 1 , Richard Burwick 2 , Raina Fichorova 3 , Hassan Dawood 3 , Hidemi Yamamoto 3 , Bruce Feinberg 2 1 Brigham and Women’ s Hospital, Harvard Medical School, 1Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, 2 Brigham and Women’ s Hospital, Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Division of Maternal Fetal Medicine, Boston, MA, 3 Brigham and Women’ s Hospital, Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Laboratory of Genital Tract Biology, Boston, MA OBJECTIVE: The nature of kidney injury at specific regions within the nephron for preeclampsia (PE) is poorly understood. Our study aims to utilize existing urinary biomarkers to describe the pattern of kidney injury and proteinuria in pregnancies affected by PE. STUDY DESIGN: We performed a case-control study of pregnant women from Brigham and Women’ s Hospital from 2012 to 2013. We matched cases of severe PE (n¼25) 1:1 by parity and gestational age to two controls groups: chronic hypertensive (cHTN) controls (n¼25) and normotensive controls (n¼25). Urinary levels of C5b-9, kidney injury molecule 1 (KIM-1) were measured by ELISA, creatinine was measured by colorimetric assay, all other markers [albumin, beta 2 microglobulin (B2M), cystatin C, epithelial growth factor (EGF), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), uromodulin (UMOD)] were measured simul- taneously with a multiplex electrochemiluminescence assay. Median values between groups were compared with the Wilcoxon sign-rank test and correlations with Spearman’ s correlation coefficient. RESULTS: Analysis of urinary markers revealed higher excretion of albumin, KIM-1 and C5b-9 and lower excretion of NGAL and EGF in PE compared to cHTN and healthy controls. Cystatin C excretion was highest in cHTN but similar between PE and controls. Excretion of B2M, OPN, and UMOD was similar. Urinary albumin excretion correlated with increased C5b-9 (r¼0.79, p<0.0001) and KIM-1 (r¼0.54, p<0.0001). Increased levels of urinary C5b-9 and KIM-1 but not albumin correlated with decreased NGAL and EGF excretion. CONCLUSION: Utilizing a comprehensive panel of biomarkers we present a novel picture of kidney injury in PE characterized by glomerular injury (albumin) but also complement-mediated inflammation (C5b-9) with likely damage to the proximal tubule (KIM-1) and renal parenchyma (EGF). Differences in cystatin C and NGAL excretion in cHTN and PE may reflect varying acuity of the two processes, but complement effects were unique to PE suggesting a pathogenic role in disease. Poster Session II Hypertension, Diabetes, Prematurity, Physiology www.AJOG.org S176 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2014