This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Wanda K. Nicholson, MD, MPH is seeking this K23 award to study the role of inflammatory markers as predictors of gestational diabetes mellitus (GDM) and incident Type 2 diabetes mellitus (Type 2 DM), to complete advanced training in the conduct of longitudinal studies, and to transition to an independent career in clinical research. Dr. Nicholson is an Assistant Professor in the Department of Gynecology and Obstetrics at Johns Hopkins and has fellowship training in clinical research and an early track record of peer reviewed clinical research. Parity has been previously linked to Type 2 DM; however, the underlying mechanism for this association is unclear. Recently, markers of inflammation (e.g. C-reactive protein) have emerged as independent predictors of Type 2 DM. No studies have examined whether the association of parity with Type 2 DM is mediated by the presence of inflammation. Moreover, it is unclear whether inflammatory markers are also predictors of GDM. The purpose of this study is to determine the effect of parity and inflammatory markers on development of gestational diabetes mellitus. We propose to conduct a case-cohort study in which we will recruit 300 women in the first trimester of pregnancy and measure inflammatory markers during the first, second, and third trimesters of pregnancy to determine the predictive value of inflammatory marker levels in the development of gestational diabetes mellitus. We plan to measure first, second, and third trimester levels of C-reactive protein, Interleukin-6, and tumor necrosis factor-alpha. In addition, we will obtain random glucose blood levels in the first and second trimester to identify any prevalent cases of glucose intolerance. We plan to conduct the study over a 16 month period in which we recruit patients and follow them up until the time of their diagnosis of gestational diabetes mellitus between 24 and 32 weeks of gestation.