650: Perinatal outcomes in women with an early diagnosis of gestational diabetes mellitus

Abstract

Women with diabetes complicating pregnancy have increased perinatal and maternal morbidity and mortality. The International Association of Diabetes and Pregnancy Group and American College of Obstetricians and Gynecologists recommend early screening for gestational diabetes mellitus (GDM) in high-risk women. Data evaluating outcomes in this population are mixed. Our hypothesis was that women with early diagnosis GDM and type 2 diabetes mellitus (T2DM) have worse perinatal outcomes in comparison to traditionally diagnosed GDM. A single center, retrospective cohort study was conducted from January 1, 2011 to January 1, 2018. Groups included women with T2DM, GDM diagnosed at < 20 weeks’ gestation and GDM diagnosed at ≥ 20 weeks’ gestation. Multivariable logistic regression was used to evaluate associations between diabetes groups and perinatal outcomes: preterm delivery (PTD), respiratory distress syndrome (RDS), birth weight (BW), NICU admission, cesarean delivery (CD) and neonatal hypoglycemia. Multivariate models were adjusted for race, parity and insurance status. Of 2201 singleton pregnancies included, 1455 had GDM ≥ 20 weeks, 211 had GDM < 20 weeks and 535 had T2DM (Table1). In comparison to women with GDM ≥ 20 weeks, women with T2DM had significantly higher risk of all perinatal outcomes: adjusted odds ratios (aOR) were PTD 2.52, RDS 1.46, BW > 4000 g 1.46, NICU admission 1.66, CD 1.90 and neonatal hypoglycemia 2.87. For GDM < 20 weeks, the odds of NICU admission were significantly lower: aOR 0.63. The remainder of outcomes for GDM < 20 weeks did not reach statistical significance. (Table 2) While current clinical guidelines recommend early GDM screening for high-risk women, our findings do not demonstrate worse perinatal outcomes for women diagnosed with GDM early compared to women with GDM diagnosed ≥ 20 weeks. Further evidence is needed to assess the value of early GDM screening in high-risk women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)