(1094) Postpartum Hemorrhagic Morbidity in Those With Versus Without Diabetes Mellitus

There is conflicting evidence on the role of hyperglycemia and postpartum hemorrhage. Due to vascular and perfusion abnormalities, we hypothesized that post-partum hemorrhagic morbidity would be higher among those with versus without diabetes mellitus (DM—gestational or pregestational). Our objective was to compare the composite of maternal hemorrhagic morbidity (CMHM) in those with and without DM.

Study Design: This was a retrospective cohort study of all singleton deliveries ≥ 14 weeks at a Level IV center between March 2020 and February 2022. Inclusion criteria were those with known DM status. The primary outcome was a composite maternal hemorrhagic-morbidity (CMHM) defined as: blood loss ≥ 1000 mL, use of uterotonics (excluding prophylactic oxytocin), mechanical tamponade, surgical intervention for atony (O’Leary, B-Lynch, or uterine artery embolization), blood transfusion, venous thromboembolism, admission to the intensive care unit, hysterectomy, or maternal death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR), adjusted with variables identified in the univariate analysis

Results: Of the 8,623 deliveries during the study period, 8,357 (97%) met the inclusion criteria. and among them 1,003 (12.0%)—632 (63%) with GDM and 371 (37%) with pregestational—had DM and the remaining 7,354 (88.0%) individuals did not. There were no significant differences in CMHM between the groups (without diabetes 20.6% vs. with diabetes 27.3%; aRR 1.08, 95% CI 0.96-1.22). In subgroup analysis comparing those without diabetes compared to those with gestational diabetes, there was no significant difference (20.6% v. 25.2%; aRR 1.09, 95% CI 0.95-1.26). Similarly, examining those without diabetes compared to those with pregestational diabetes, there was no significant difference (20.6% v. 31.0%; aRR 1.05, 95% CI 0.89-1.24) (Table 1). 

Conclusion: In our population, pregnancies complicated by diabetes were not at a significantly higher risk of hemorrhagic-related morbidity compared to those without diabetes.