Differences in Obstetric and Neonatal Outcomes in Pregnancies Complicated by Type 1 and Type 2 Diabetes Mellitus [21H

Abstract

INTRODUCTION: There are well-known baseline differences in medical comorbidities and disease related complications between patients with pregestational type 1 and type 2 diabetes, but limited research on the comparison in obstetric outcomes between these populations. METHODS: Retrospective cohort study of all pregnancies complicated by pregestational diabetes from 2012-2016. Patients were categorized by diabetes type and baseline demographics were compared between groups. A multivariate regression model was used to calculate adjusted odds ratios for obstetric and neonatal outcomes controlling for gestational age at delivery and late (>26 weeks) hemoglobin A1c. RESULTS: There were 464 patients who met inclusion criteria during the study period. Patients with type 2 diabetes were more likely to be of non-Hispanic white race (36.2% vs. 15.2%; p<.01), advanced maternal age (40.8% vs. 19.3%; p<.01), obese (81.7 vs. 46.2%; p<.01) and have preexisting hypertension (41.0% vs. 20.1%; p<.01). However, patients with type 1 diabetes had a longer duration of disease (White’s class C/D: 62.1% vs 19.5%; p<.01) and higher rates of end organ complications (White’s class R/F:19.3% vs 3.5%; p<.01). Adverse obstetric and neonatal outcomes were more common in type 1 diabetes including prematurity (aOR:1.8, CI:1.1-2.8), NICU admission (aOR:1.9, CI:1.1-3.2), and large for gestational age birth weight (aOR:2.5, CI:1.6-4.0). Whereas, patients with type 2 diabetes had a higher burden of spontaneous abortion (6.0% vs. 0.7%; p=0.01) and fetal demise (2.5% vs. 0%; p<.06). CONCLUSION: Despite lower rates of baseline medical co-morbidities, patients with type 1 diabetes have higher rates of preexisting diabetes complications and adverse perinatal outcomes independent of antenatal glycemic control.