597 Impact on neonatal outcomes with late preterm and early term delivery in women with diabetes

Abstract

Late preterm and early term deliveries are common in pregnancies complicated by diabetes because of higher rates of obstetric complications, as well as concerns of increased stillbirth risk. Early delivery is associated with multiple neonatal adverse outcomes. The aim of this study was to investigate the rates of adverse neonatal outcomes with delivery at late preterm and early term gestational ages in women with either pregestational or gestational diabetes (GDM). This was a retrospective cohort study of all women with a singleton, non-anomalous pregnancy delivering at a single academic medical center in the late preterm (34 0/7-36 6/7 weeks) or early term (37 0/7-38 6/7 weeks) period between 2010-2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or GDM. Multivariate logistic regression was used to calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent. There were 8,072 pregnancies included in the analysis with T1DM, T2DM, and GDM complicating 1.8%, 5.6%, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups such as higher rates of non-Hispanic Black race, chronic hypertension and higher BMI in women with T2DM (all p<.001, Table 1). The probability of severe composite adverse neonatal outcome was significantly increased with late preterm delivery in women with T1DM (aOR 3.2; CI 1.5-6.6) and GDM (aOR 1.0; CI 1.01-3.5), but this was largely driven by need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery, but highest in women with T1DM (Table 2). Pregnancies complicated by diabetes, particularly those with T1DM, have higher rates of neonatal adverse outcomes independent of gestational age of delivery. These data are important to consider when late preterm and early term delivery is planned in these pregnancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)