355 Risk factors for moderate-to-severe polyhydramnios among patients with diabetes

Abstract

Nearly 20% of polyhydramnios is attributed to poorly controlled or undiagnosed diabetes, yet we do not have guidance for who to watch closely for polyhydramnios. We aimed to identify risk factors for moderate to severe polyhydramnios in pregnancies complicated by diabetes. This is a nested case-control study of patients with pre/gestational diabetes with singleton pregnancies complicated by polyhydramnios from 2014-2018. Patients with multiple gestations, fetal anomalies, and chromosomal abnormalities were excluded. Polyhydramnios was defined by a deepest vertical pocket (DVP) > 8 cm or amniotic fluid index (AFI) > 24 cm after the 20th week of gestation. Cases were moderate or severe polyhydramnios (defined as AFI >30 or DVP >12 cm), while controls were mild polyhydramnios (defined as AFI 24.0-29.9 or DVP 8-11 cm). Diabetes-related exposures were compared between groups. Unadjusted and adjusted odds ratios were calculated using multivariable logistic regression. Of 90 patients with pre/gestational diabetes, 12 (13.3%) had moderate/severe polyhydramnios. Tobacco use (45.5% vs 17.1%, aOR [95% CI] 5.60 [1.34, 23.3] was the only risk factor associated with moderate/severe polyhydramnios. Fewer women in the moderate/severe polyhydramnios group took antihypertensive medication (0% mod/severe vs. 29.5% mild, p=0.03). Diabetes-specific exposures, such as hemoglobin A1c and glucose screening results, were similar between groups. Tobacco use is a modifiable risk factor associated with moderate/severe polyhydramnios in patients with diabetes. Provided established maternal and fetal risks associated with moderate/severe polyhydramnios, there may be utility in optimizing this risk factor.