Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000–2019

Abstract

Pregestational diabetes and associated risks may be increasing in the obstetric population. To characterize trends in delivery hospitalizations with pregestational diabetes, prevalence of chronic diabetes complications, and risk for adverse outcomes. This repeated cross-sectional study used the National Inpatient Sample to identify delivery hospitalizations between 2000 and 2019 with pregestational diabetes. Trends in pregestational diabetes delivery hospitalizations were assessed using Joinpoint regression to determine the average annual percent change (AAPC). Trends in chronic diabetes complications including chronic kidney disease, neuropathy, peripheral vascular disease, and diabetic retinopathy were also analyzed. The risk of adverse obstetric outcomes was compared between patients with and without pregestational diabetes using adjusted logistic regression models accounting for demographic, clinical, and hospital characteristics with adjusted odds ratios (aORs) with 95% CIs as measures of association. Of 76.7 million delivery hospitalizations, 179,885 (0.23%) had type 1 diabetes (T1DM), 430,544 (0.56%) had type 2 diabetes (T2DM), and 99,327 (0.13%) had unspecified diabetes. From 2000 to 2019, the prevalence of diabetes increased from 1.8 to 7.3 per 1,000 deliveries for T2DM (AAPC 8.0%, 95% CI 6.9%, 9.2%), 1.5 to 3.2 for unspecified diabetes (AAPC 3.9%, 95% CI 1.4%, 6.3%), and 2.7 in 2000 to 2.8 (AAPC 0.2% 95% CI -0.8%, 1.3%) for T1DM. The prevalence of chronic diabetes complications increased from 2.7% to 5.6% over the study period (AAPC 5.9%, 95% CI 3.7%, 8.0%). Pregestational diabetes was associated with severe maternal morbidity, cesarean delivery, hypertensive disorders of pregnancy, preterm birth, and shoulder dystocia. Pregestational diabetes increased over the study period, driven by a quadrupling in the prevalence of T2DM. Notably, the prevalence of chronic diabetes complications doubled concomitantly. Pregestational diabetes was associated with a range of adverse outcomes. These findings are further evidence that pregestational diabetes is an important contributor to maternal risk and that optimizing diabetes care in women of childbearing age will continue to be of major public health importance.