Perinatal Characteristics of Women With Uncontrolled Pregestational Diabetes [38K

Abstract

INTRODUCTION: Uncontrolled diabetes in pregnancy carries risk of adverse maternal and neonatal outcomes. Glycemic control is a modifiable perinatal risk factor. Identifying demographics that are at higher risk of having uncontrolled diabetes in pregnancy is vital for improving health outcome disparities. Our objective was to compare perinatal characteristics of pregnant women with controlled and uncontrolled pregestational diabetes in a large cohort in California state. METHODS: This is a retrospective cohort study of singleton gestations among women with pregestational diabetes between 2007 and 2011 using linked vital statistics and ICD-9 data. Chi-square tests were used to compare perinatal characteristics between patients with controlled and uncontrolled diabetes during pregnancy. Uncontrolled diabetes status was defined by the delivering clinician. Multivariable logistic regression was used to estimate adjusted odds ratio (aOR), controlling for maternal age, education, parity, previous diagnosis of chronic hypertension, race, insurance status and tobacco use. RESULTS: In a cohort of 18,198 pregnant women consisting of 785 uncontrolled diabetics and 17,413 controlled diabetics, we found that pregnant women with uncontrolled diabetes were more likely to be black women, less than 20 years of age, hold a diagnosis of chronic hypertension, or have attended less than 5 prenatal visits. The other examined characteristics of interest did not show statistical significance. CONCLUSION: Teenage pregnancy, black race, chronic hypertension, and limited prenatal care are associated with uncontrolled pregestational diabetes. To improve health outcome disparities, these populations should be specifically targeted with planned resource allocation for the treatment of diabetes in pregnancy.