(920) Adverse outcomes in patients with early dysglycemia in pregnancy compared with preexisting type 2 diabetes

ACOG and ADA recommend screening for undiagnosed pregestational diabetes (DM) at prenatal care onset, but the benefit of screening for early dysglycemia that is not overt DM remains unclear. We aimed to compare outcomes among patients with early dysglycemia to those with preexisting type 2 DM (T2D).

Study Design:

This was a secondary analysis of a randomized, placebo-controlled trial of metformin for insulin-treated T2D in pregnancy. Participants with baseline HbA1c and primary composite outcome data (Table 2) were included. Those diagnosed with DM during pregnancy with HbA1c > 6.5% or missing method of diabetes were excluded. Early dysglycemia was defined as abnormal 2-step, 1-step, or 1hr GCT < 23 weeks and HbA1c < 6.5%. We compared baseline characteristics and outcomes between patients with early dysglycemia, T2D with good control (HbA1c < 6.5%) and T2D with poor control (HbA1c ≥ 6.5%). Multivariable logistic regression estimated the association of early dysglycemia with outcomes, compared to T2D with good control and to T2D with poor control.

Results:

Of 610 eligible participants, 83 (14%) had early dysglycemia, 150 (24%) T2D with good control, and 377 (62%) T2D with poor control. Groups differed by multiple baseline characteristics (Table). Composite neonatal morbidity differed by maternal DM status (46% vs 58% vs 82%) as did all secondary outcomes (Figure). Compared to T2D with good control, early dysglycemia was not associated with the neonatal composite, but had lower odds of hyperbilirubinemia (Figure). Compared to T2D with poor control, early dysglycemia was associated with lower odds of neonatal composite (aOR 0.33, CI 0.16-0.67) and other secondary outcomes (Figure).

Conclusion:

In this diverse cohort with detailed data on DM diagnosis and HbA1c in early pregnancy, patients with early dysglycemia appeared to have outcomes similar to those with well-controlled preexisting T2D, but improved outcomes compared to those with poorly-controlled T2D. These findings may inform counseling and management of patients diagnosed with early dysglycemia without overt T2D.