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Clinical Obstetrics

Poster Session 4

(1016) Late preterm antenatal steroids in women with gestational diabetes mellitus

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Multiple reports indicate that severe maternal morbidity (SMM) is increasing. Whether this increase is due to change in patient characteristics or practice patterns is not adequately evaluated. Our objective was to examine the temporal trends of SMM in the US population in relation to trends in maternal characteristics

Study Design: We performed a repeated cross-sectional analysis of US birth certificate data from 2011 to 2021. Our primary outcome was SMM defined as the occurrence of intensive care unit admission (ICU), eclampsia, uterine rupture, blood product transfusion, and hysterectomy. We also examined the proportions of age ( > 44 years), BMI ( >40 kg/m2 and >50 kg/m2), > 3 prior cesareans, pregestational diabetes, multiple gestation, no prenatal care, chronic hypertension, and assisted reproductive technology. The incidence rate ratio per year (IRR) was calculated using negative binomial regression

Results: There were 42,519,424 births from 2011 to 2021. Figure 1 shows statistically significant increases in the rates of patient with age >44 years (IRR 1.03 [95% CI 1.03-1.04]), BMI >40 kg/m2 (IRR 1.06 [95% CI 1.06-1.06]), BMI >50 kg/m2 (IRR 1.07 [95% CI 1.07-1.07]), no prenatal care (IRR 1.04 [95% CI 1.04-1.05]), chronic hypertension (IRR 1.07 [95% CI 1.06-1.07]), pregestational diabetes (IRR 1.06 [95% CI 1.06-1.06]), and >3 prior cesarean (IRR 1.08 [95% CI 1.07-1.08]). There were statistically significant increases in SMM (IRR 1.03 [95% CI 1.02-1.03]), ICU (IRR 1.04 [95% CI 1.03-1.05]), eclampsia (IRR 1.02 [95% CI 1.01-1.02]), hysterectomy (IRR 1.04 [95% CI 1.03-1.05]), uterine rupture (IRR 1.05 [95% CI 1.04-1.06]), and transfusion (IRR 1.09 [95% CI 1.08-1.09]). However, these were no longer significant after adjusting for the increase in BMI >40 kg/m2, age >44 years, and no prenatal care

Conclusion: SMM increased over the past decade, but this increase was not out of proportion to the temporal trends in maternal characteristics. Addressing SMM requires tackling issues that are not directly related to the index pregnancy