Poster Session 1
Category: Diabetes
Poster Session 1
Christina M. Boulineaux, MD
Resident Physician
Department of Obstetrics and Gynecology, University of Alabama at Birmingham
University of Alabama at Birmingham, Alabama, United States
Claire A. McIlwraith, MD
Fellow Physician, Maternal Fetal Medicine
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Amanda Assad, BS
Department of Obstetrics and Gynecology, University of Alabama at Birmingham
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama, United States
Christina T. Blanchard, MS
Statistician
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Ashley N. Battarbee, MD, MSCR
Associate Professor, Maternal-Fetal Medicine
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
To identify risk factors for stillbirth among pregnant individuals with diabetes mellitus (DM).
Retrospective cohort study of pregnant patients with gestational or pregestational DM who received prenatal care and delivered at a tertiary care center (2012-2025). The primary outcome was stillbirth. Secondary outcomes included gestational age (GA) at stillbirth and composite severe neonatal morbidity (Table 2). Descriptive statistics were used to summarize the study cohort, and multivariable logistic regression with backward selection identified the factors that were independently associated with stillbirth and secondary outcomes.
Among 5,737 included patients, 121 (2.1%) stillbirths occurred at an average GA of 27.9±8.0 weeks. The cohort included 68.2% patients with gestational DM, 22.4% type 2 DM, and 9.4% type 1 DM. Mean maternal age was 30.5±5.9 years, with 41.9% patients identifying as black race (Table 1). In multivariable analysis, third trimester HbA1c was the only factor significantly associated with stillbirth (aOR 1.41, 95% CI 1.01-1.97). For GA at stillbirth, maternal age, self-identifying as black or white race (compared with other race), gestational DM (compared with type 2), higher HbA1c in early pregnancy and preeclampsia were associated with later GA at stillbirth (Table 2). Higher HbA1c in the third trimester was associated with earlier GA at stillbirth (Table 2). For severe neonatal morbidity, type 1 DM (compared to type 2) and chronic hypertension were significant risk factors (Table 2). In sensitivity analyses stratified by DM type, among patients with type 2 DM, higher third trimester HbA1c (aOR 1.66, 95% CI 1.07-2.58) and multiple gestation (aOR 6.80, 95% CI 1.30-35.53) were associated with increased stillbirth risk. No independent risk factors were identified among patients with gestational or type 1 DM.
Third trimester HbA1c emerges as the primary modifiable risk factor for stillbirth in patients with DM. Racial disparities in stillbirth timing and DM type-specific risk patterns warrant targeted surveillance strategies for high-risk populations.