(1024) Adverse outcomes in individuals with recurrent gestational diabetes mellitus in subsequent pregnancies.

Gestational diabetes (GDM) makes up 8-10% of all annual pregnancies in the United States. A prior diagnosis of GDM in a previous pregnancy is a well-established risk factor for recurrence in subsequent pregnancies. However, data examining maternal and neonatal outcomes specifically in the setting of recurrent GDM remains limited. The purpose of this study is to examine the risk of adverse maternal and neonatal outcomes among individuals with a current GDM diagnosis and a history of GDM in a prior pregnancy. 

Study Design:

A retrospective cohort study using linked birth certificate hospital discharge data in California from 2008 - 2020 was conducted to examine the association of recurrent preeclampsia with adverse maternal and neonatal outcomes. We included singleton, non-anomalous births with gestational age of 23-42 weeks. Chi-square tests and multivariable Poisson regression models were employed to evaluate the association between recurrent GDM and the risk of adverse outcomes when compared to those without recurrent GDM. 

 

Results:

Overall, among those with GDM in their first pregnancy, 56% had recurrent GDM in the subsequent pregnancy (n = 37,928). Within the recurrent GDM population, 46% of patients were categorized as obese, 26% as overweight, 26% as normal weight, and 1% underweight. Recurrent GDM was associated with increased risk of preterm birth (aRR 1.18, 95% CI 1.13–1.25) and preeclampsia (aRR 1.33, 95% CI 1.26–1.40). Neonates born to mothers with recurrent GDM had higher risk of NICU admission (aRR 1.18, 95% CI 1.13–1.24), large for gestational age (aRR 1.21, 95% CI 1.17–1.25), shoulder dystocia (aRR 1.24, 95% CI 1.11–1.40), and brachial plexus injury (aRR 2.36, 95% CI 1.53 - 3.63).

 

Conclusion:

Recurrent gestational diabetes mellitus is linked to a range of adverse maternal and neonatal outcomes, including preeclampsia, cesarean delivery, and complications related to fetal overgrowth. These results emphasize the importance of early identification and individualized care for patients with a history of GDM to mitigate risks in subsequent pregnancies.