397: Neonatal risks associated with maternal glucose intolerance in the absence of gestational diabetes

Abstract

To determine whether mild maternal glucose intolerance in the absence of diabetes is associated with neonatal complications, independent of maternal BMI. This is a secondary analysis of the prospective cohort study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Women were included if they had any testing for glucose intolerance. Women were excluded if they had a diagnosis of gestational or pregestational diabetes or if they delivered preterm. The exposure of interest was maternal glucose intolerance, defined as any of the following: HbA1c ≥5.7%, elevated 1 hour glucose tolerance test (GTT) >135 and <200, fasting glucose ≥92, or any random glucose measurement ≥200. The primary outcome of interest was a composite of adverse neonatal outcomes including LGA birthweight >97%ile, hypoglycemia requiring treatment, and shoulder dystocia. Bivariate analyses compared women with glucose intolerance to women without glucose intolerance across demographic and clinical factors (Table 1). Odds ratios for the outcome of interest were compared between exposed and unexposed women using multivariable logistic regression to adjust for possible confounders (Table 2). Stratified analyses assessed the interaction of maternal BMI using the Mantel-Haenszel test and Taurone’s test of homogeneity. Of the 7,680 women included, 6624 (86.25%) had no glucose intolerance and 1056 (13.75%) met criteria for glucose intolerance. In bivariate analyses, women with glucose intolerance were older, less likely to be non-Hispanic black, and more likely to be overweight. Multivariable analyses revealed a significant increase in odds of LGA and shoulder dystocia among infants of women with glucose intolerance (OR 1.66, 95% CI 1.04-2.67 and OR 1.71, 95% CI 1.08-2.70, respectively). There was no difference between the groups in the primary composite neonatal outcome (OR 1.12, 95% CI 0.62-2.00). Stratified analyses demonstrated no difference in these associations by BMI category, indicating an independent relationship between glucose intolerance, LGA, and shoulder dystocia. Maternal glucose intolerance without a diagnosis of diabetes may still predict clinically significant neonatal complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)