433 - Gestational Diabetes and associated maternal, neonatal and perinatal outcomes in an African-American Inner-City Population

Poster Number: 433
Publication Number: 433.137

Ahreen Allana, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Faisal Siddiqui, SUNY DOWNSTATE MEDICAL, Brooklyn, NY, United States; mahasin Taha, SUNY downstate, Brooklyn, NY, United States; Adedapo Kiladejo, State University of New York Downstate Medical Center College of Medicine, brooklyn, NY, United States; Mmeyeneabasi Omede, SUNY Downstate Medical center, Brooklyn, NY, United States; Simran Patel, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Lori Hoepner, SUNY Downstate School of Public Health, Brooklyn, NY, United States; Lawrence Fordjour, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States

Background: Gestational diabetes mellitus (GDM) affects 2-10 % of all pregnancies in the United States. The prevalence of maternal obesity and GDM continues to rise. Studies have shown higher rates of GDM amongst certain ethnic groups, with an increased risk of adverse maternal and neonatal outcomes.

Objective: To determine the correlation between maternal gestational/pre-gestational diabetes and maternal obesity with adverse maternal and neonatal outcomes in an African- and Caribbean-American inner-city population.

Design/Methods: This was a retrospective chart review of neonates born to mothers with GDM delivered at the University Hospital of Brooklyn from 2014 to 2018. Maternal, peripartum and neonatal outcomes were analyzed. GDM was defined per National Diabetes Data Group. Maternal Body Mass Index (BMI) was defined per National Institutes of Health. Maternal outcomes included C-section delivery, chronic hypertension and preeclampsia whereas neonatal outcomes included large for gestational age (LGA) defined as birth weight (BW) ≥ 90th percentile for gestational age (GA), preterm labor (delivery before 37 weeks), hypoglycemia, hyperbilirubinemia and respiratory distress.

Results: Among 6426 singleton live births between 2014 and 2018, 490 (7.6%) mothers were found to be diabetic during pregnancy. Mothers identified were mostly African American (91%), with mean age of 32 years, and mean BMI 36.1kg/m2 with 77% of these women being classified as obese. A greater proportion of mothers had diet controlled GDMA1 (51%) vs oral hypoglycemic or insulin controlled GDMA2 (44%); while pre-gestational DM accounted for 5% of all cases. Maternal outcomes included a 16% incidence of preeclampsia and chronic hypertension, and a  56% C-section rate. Amongst neonates, the mean GA was 37 weeks, mean BW 3384g and 54% of them were male. Neonatal outcomes included LGA (11.6%), preterm delivery (10.6%), hypoglycemia (19.2%), respiratory distress necessitating respiratory support (16%), and jaundice (17%). Of note, maternal BMI was found to directly co-relate with certain adverse neonatal outcomes. The proportion of LGA newborns was 13.8% in women who had a BMI ≥30kg/m2 compared with 6.5% in non-obese women. Similarly, the rate of neonatal hypoglycemia was higher (20.9%) in obese women compared with 11.2% in non-obese women.Conclusion(s): We report a high incidence of GDM associated with higher BMI in inner city African American women. Additionally, women with GDM and high BMI have worse maternal and neonatal outcomes. Early counseling and monitoring of pregnancy weight gain can lead to improved maternal and neonatal outcomes.