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Adiposity significantly contributes to reproductive function. Whereas lower body weight is strongly associated with increased risk of functional hypothalamic amenorrhea (FHA), the relationship between BMI and the timing of menopause is poorly understood. Recent studies of self-reported data suggest women with BMI<18.5kg/mg 2 have a significantly higher risk of menopause before age 45 years. However, without confirmatory testing, there is the possibility of misdiagnosis of menopause given the prevalence of FHA in low-weight women. Although FHA and menopause are clinically identical, laboratory evaluation could potentially aid in differentiating the two entities, as menopause is characterized by high gonadotropin levels, whereas FHA is characterized by low-normal gonadotropin levels. Given the increased morbidity and mortality associated with early age of menopause, this distinction is clinically important. We sought to identify age of menopause in low-weight women using clinically available data at a large, academic health system. We hypothesized that women with a BMI<18.5kg/m 2 would have a lower age of menopause but that confirmatory diagnostic testing to differentiate menopause from FHA would be infrequently performed. The study was conducted by retrospective chart review of the electronic medical records of 3,000 women >50 years of age and BMI<18.5kg/m 2 . After exclusion of individuals with no date of menopause, BMI>18.5 kg/m 2 at the menopausal transition and history of known cause of early menopause, 239 charts were included in the analysis. Participants had a median BMI of 17.7kg/m 2 at the final menstrual period (FMP). Median age at the FMP in all low weight women with BMI<18.5kg/m 2 was 51 years. There was a positive correlation between age of the FMP and BMI (rho=0.13, p=0. 04). When stratified by BMI, age of the FMP decreased with decreasing BMI. For women with a BMI of 18-18.49kg/m 2, FMP occurred at a median age of 51 years; for women with a BMI of 16-17.99 kg/m 2, FMP occurred at a median age of 50 years; and for women with BMI<16kg/m 2, FMP occurred at a median age of 48 years. Only 30 women (12.6%) included in the study had an FSH level measured after diagnosis of menopause and eight of these women (26.67%) had an FSH<18 (range: 0.7-14.7 IU/mL), which is lower than expected for menopause. Therefore, these data, obtained from clinical data rather than self-report, provide further evidence that low-BMI is associated with lower age of menopause. Although current societal guidelines do not recommend diagnostic evaluation of menopause in women older than 45 years, our data suggest that there is a risk of misclassifying FHA as menopause in low-weight women if diagnostic evaluation is not performed. Further studies are necessary to determine the role and clinical benefit of diagnostic confirmation of menopause in low-weight women with amenorrhea. Presentation: No date and time listed

Underweight body mass index (BMI) is defined as a BMI <18.5 kg/m2 and a subset of low-weight women also meet DSM-5 criteria for a diagnosis of anorexia nervosa. Although anorexia nervosa is often associated with functional hypothalamic amenorrhea and resultant infertility, when women with anorexia nervosa do conceive, there is an increased risk of obstetrical and delivery complications, and poor neonatal outcomes, such as preterm birth, low birth weight, and smaller size for gestational age (SGA). Few studies have investigated such outcomes in women who are low weight, with or without a diagnosis of anorexia nervosa. The aim of the study was toexamine associations between underweight maternal BMI and pregnancy complications and neonatal outcomes in mothers and infants at a large academic medical center. There was a total of 16,780 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5 kg/m2 (n=732) or who were normal-weight (18.5 kg/m2 < BMI <25 kg/m2, n=16,048) at their initial prenatal visit or within six months of that visit. We compared neonatal outcomes and pregnancy/delivery complications in the low-weight versus normal-weight mother-infant pairs. Neonatal outcomes included birthweight, gestational age, NICU stay, preterm birth, and fetal death; pregnancy and delivery complications included pre-eclampsia/eclampsia, premature rupture of membranes (PROM), and post-partum hemorrhage. Median BMI in underweight women was 17.8 [interquartile range: 17.2, 18.1] kg/m2 compared with 22.2 [20.7, 23.6] kg/m2 in normal-weight women. Underweight women were younger (27 [22, 31] years) and less likely to be married or have private insurance (p-value <0.0001 for all). Approximately 22% of the low-weight mothers were African American compared with 13.4% of normal-weight mothers (overall p-value for race/ethnicity <0.0001). Additionally, approximately 22% of infants born to low-weight mothers were SGA and 15% with low birthweight compared with 13.6% and 9% of infants born to normal-weight mothers, respectively (p-value <0.0001 for both SGA and low birthweight). These differences remained significant after adjusting for maternal age, race/ethnicity, marital and insurance status, and maternal depression; after adjusting for these potential confounders, infants born to low-weight mothers had increased risk for SGA (OR=1.23, 95% CI: 1.11-1.36) and low birthweight (OR=1.18, 95% CI: 1.04-1.33) compared with their normal-weight counterparts. In adjusted models, underweight women had decreased risk of PROM (OR=0.85, 95% CI: 0.74-0.98) and post-partum hemorrhage (OR=0.72, 95% CI: 0.54-0.96) compared to normal-weight women. No differences were noted for pre-eclampsia/eclampsia, NICU stay, preterm birth, and fetal death. In summary, underweight BMI during pregnancy is associated with an increased risk of infants who are SGA and low birthweight and a decreased risk for delivery complications including PROM and post-partum hemorrhage. These differences suggest underweight BMI during pregnancy increases the risk for adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Luchador and Nerujay are two newly isolated mycobacteriophages recovered from soil samples using Mycobacterium smegmatis. Their genomes are 53,387 bp and 53,455 bp long and have 96 and 97 predicted open reading frames, respectively. Nerujay is related to subcluster A1 phages, and Luchador represents a new subcluster, A14.

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