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Diabetes

Poster Session 1

(168) Perinatal outcomes in pregnancies affected by early abnormal glucose tolerance

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Presenting Author(s)

  • Erin Gallent, MD, PhD (she/her/hers)

    Kaiser Permanente Los Angeles Medical Center
    Los Angeles, CA, United States

    • Coauthor(s)

  • QL

    Qiaowu Li, MS

    Kaiser Permanente Southern California Department of Research and Evaluation
    Pasadena, CA, United States

    • Primary Author(s)

  • BB

    Brianne Bimson, MD

    Kaiser Permanente Los Angeles Medical Center
    Los Angeles, CA, United States

Objective:

Abnormal glucose tolerance (AGT) in the third trimester, defined as 1 of 4 elevations on an oral glucose tolerance test (OGTT), is associated with increased risk for adverse pregnancy outcomes. Using universal rather than risk-based screening, we aimed to determine if AGT in early pregnancy was similarly associated with perinatal complications.

Study Design:

This study was a retrospective cohort study that reviewed 70,921patients with pregnancy data from three hospitals in the greater Los Angeles area that employ universal gestational diabetes mellitus (GDM) screening in early pregnancy between the years 2010 and 2020. Per protocol, all patients are screened for GDM at the time of prenatal intake using the 2-step method. The primary outcome was large for gestational age (LGA) neonate. Secondary outcomes were a maternal composite and a neonatal composite.

Results:

56,266 patients were identified who successfully completed the 1 hour 50-gram oral glucose challenge screening prior to 18 weeks gestational age. 6,294 patients met criteria for AGT on diagnostic evaluation with the 3 hour 100-gram OGTT using Carpenter-Coustan criteria. 6,294 matched controls with normal screening were identified. There were no significant differences in the primary outcome of LGA between groups (4% vs 4.1%, p=0.7186). Regression analyses revealed patients with early AGT were more likely to develop GDM compared to controls (29% vs 9.6%, OR 3.95 CI 3.55-4.40, p< 0.0001). There was also a significant difference in the rate of primary cesarean section for patients with early AGT (OR 1.11 CI 1.00-1.22, p=0.045).

Conclusion:

Using universal GDM screening in early pregnancy, we found no association between early AGT and increased incidence of LGA newborns. However, early AGT was associated with an increased risk for GDM diagnosis in the third trimester as well as primary cesarean section. Further investigation into the use of risk based GDM screening in early pregnancy is warranted, as well as early implementation of healthy lifestyle counseling.