Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Diabetes

Poster Session 4

(1035) Racial and ethnic disparities in treatment strategies and pregnancy outcomes of women with gestational diabetes

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Rate of gestational diabetes (GDM) is disparate among racial and ethnic backgrounds (R/E). Guidelines vary regarding oral medication as first-line therapy. We investigated R/E disparities in GDM by initial treatment and pregnancy outcomes.

Study Design:

Single-institution retrospective cohort of 543 patients with GDM, 2015–2019. Patients were stratified by R/E based on self-report: non-Hispanic white (NHW, referent), non-Hispanic Black (NHB), Hispanic, and Asian. Diet-treated GDM and pre-pregnancy diabetes were excluded. Pregnancy outcomes and initial therapy regimen (insulin versus oral) were compared between R/E using generalized linear modeling. Multinomial logistic regression was used to determine relative risk (RR) of pregnancy outcomes after adjusting for relevant factors (aRR).

Results:

Cohort was 44.6% NHW, 29.7% NHB, 14.7% Hispanic, and 11.1% Asian. Highest rate of initial insulin therapy was in NHW (26%), compared with 24%, 8%, and 18% in NHB, Hispanic, and Asian R/E, respectively, RR: 1.4 (1.03-2.0). Initial oral therapy was highest in Hispanic (93%), compared with 74%, 76%, and 82% in NHW, NHB, and Asian R/E,  RR: 1.3 (1.1-1.4).

Pregnancy outcomes were compared after stratifying by initial treatment and R/E (Table 1). Cesarean and large for gestational age differed significantly between R/E (p=0.010 and 0.007, respectively) in those with oral therapy. Hispanic with oral treatment had greater risk of birth injury, RR: 3.6 (1.04-12.3) compared to other R/E.
Compared to oral treatment, initial insulin treatment was associated with greater risk of preeclampsia (aRR: 1.75, 1.1-2.8) after adjusting for tobacco, obesity and chronic hypertension. When included in the logistic model, R/E did not significantly impact this outcome. Chronic hypertension was a significant predictor of insulin therapy, aRR: 2.7 (1.7-4.4).

Conclusion:

Racial disparities were present in initial therapy for GDM, with NHW more likely to receive insulin and Hispanic more likely to receive oral therapy. Initial insulin therapy was associated with a higher risk of preeclampsia, which may reflect underlying health status.