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Medical/Surgical/Diseases/Complications

Poster Session 3

(901) National trends and outcomes in births with co-occurring hypertensive disorders of pregnancy and gestational diabetes

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

To describe trends of births with co-occurring gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) and estimate associated odds of maternal and neonatal adverse outcomes.

Study Design:

The 2014-2021 National Vital Statistics System data was used for this analysis, excluding those with pregestational diabetes, congenital anomalies, or missing diagnoses. Trends analysis for GDM, HDP, and co-occurring GDM/HDP were conducted using Joinpoint regression with measures of association expressed as annual average percent change (AAPC) and 95% confidence intervals (CI). Unadjusted and adjusted logistic regression models were fit to assess the exposure of GDM, HDP, co-occurring GDM/HDP on composite maternal (Cesarean delivery, transfusion, perineal laceration, unplanned hysterectomy, ICU admission) and neonatal (preterm birth < 37 weeks, large/small for gestational age, NICU admission) outcomes adjusting for demographic and other clinical variables.

Results:

29.9 million births were included with prevalence of co-occurring GDM/HDP, GDM alone, and HDP alone at 0.9%, 5.7%, and 6.0%, respectively. The prevalence of co-occurring GDM/HDP increased from 0.6% to 1.3% (AAPC 10.8%, 95% CI: 9.4-12.2%), and GDM alone and HDP alone increased from 4.9% to 7.1% (AAPC 5.6%; 95% CI: 4.7-6.6%) and from 4.6% to 8.0% (AAPC 8.1%; 95% CI: 7.4-8.9%), respectively (Figure 1A). Co-occurring GDM/HDP rates showed the highest rate of increase; more than doubling from 2014 to 2021  (Figure 1B). Births with co-occurring diagnoses had higher odds of adverse maternal complications (aOR 1.85, 95% CI: 1.83-1.87; versus neither) which is marginally higher in magnitude than GDM alone (aOR 1.45, 95% CI: 1.44-1.47) and HDP alone (aOR 1.20, 95% CI: 1.19, 1.21). Similar findings were noted among neonatal outcomes.

Conclusion:

The prevalence of patients with co-occurring GDM/HDP is increasing and is associated with higher odds of maternal and neonatal complications compared to either condition alone. These findings provide real-world evidence and highlight the need for additional for this growing high-risk cohort.