1120 Perinatal outcomes by race and ethnicity following specialist gestational diabetes care

Abstract

To identify whether a dedicated Diabetes in Pregnancy Clinic (DIPC) reduces differences in rate of cesarean delivery (CD) between non-Hispanic Black (NHB) and Latina patients with gestational diabetes (GDM) compared to non-Hispanic White (NHW) patients. This is a secondary analysis of a prospective cohort of 600 patients with GDM diagnosed using Carpenter-Coustan criteria or 1 hour glucose challenge test >200 mg/dl. Patients were stratified by type of prenatal care. Women cared for at the DIPC were seen by Maternal Fetal Medicine (MFM), had access to a nutritionist and weekly contact with certified diabetes nurse educators and were compared to women cared for by an obstetrician (OB) without routine access to these additional services. Both groups delivered at the same tertiary care facility with standard protocols for labor management of patients with GDM. Baseline characteristics, obstetric and neonatal outcomes were compared using Wilcoxon rank-sum and Fisher’s exact test. The primary outcome was defined as CD. Secondary outcomes included perinatal morbidity associated with GDM. Logistic regression was performed to ascertain differences in the primary outcome of interest overall and stratified by management team. Of 600 participants, 152 (25%) received cared in the DIPC and 448 (75%) were cared for by a general OB. Patients cared in the DIPC were more often younger, NHB or Latina, had an income < $50K, and had public insurance. Overall, there was no difference in CD between patients cared in the DIPC compared to those who were not. When outcomes were assessed by race/ethnicity, NHB and Latina patients managed in the DIPC had decreased CD compared to NHW (RR 0.49, 95% CI 0.32, 0.78) while there was no difference in CD by race/ethnicity among patients with GDM cared for by a general OB. After adjusting for confounders, this finding was no longer significant (aRR 0.85, 95% CI 0.29, 2.49). Other outcomes did not differ between groups. A DIPC may assist NHB and Latina patients achieve CD rates comparable to NHW patients despite higher a priori risk for adverse outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)