427 - Adverse neonatal outcomes in women with pre-gestational and gestational diabetes mellitus in an African American inner-city population in Brooklyn, NY.

Poster Number: 427
Publication Number: 427.137

Adedapo Kiladejo, State University of New York Downstate Medical Center College of Medicine, brooklyn, NY, United States; 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; 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: Pre-gestational Diabetes Mellitus (Pre-GDM), Gestational Diabetes Mellitus (GDM) and maternal obesity have been shown to be independent risk factors for adverse neonatal outcomes. However, the association between pre-GDM and GDM in women with high BMI and its impact on neonatal outcomes remains undocumented

Objective: To determine adverse neonatal outcomes in neonates born to mothers with pre-GDM versus GDMA1 (diet controlled GDM) and GDMA2 (oral hypoglycemic or insulin controlled GDM) in an African- and Caribbean-American inner-city population

Design/Methods: We conducted a retrospective chart review on neonates born to mothers with pre-GDM and GDM at the University Hospital of Brooklyn between 2014 and 2018. Pre-GDM refers to type 1 or type 2 diabetes mellitus that is diagnosed before pregnancy. GDM was defined by the National Diabetes Data Group definition. Maternal Body Mass Index (BMI) was categorized as per World Health Organization definition. Neonatal outcomes included gestational age (GA) at birth, APGAR scores at 1 and 5 minutes of life, proportion of large for gestational age (LGA) newborns (birth weight exceeding the 90th percentile for GA), respiratory distress requiring respiratory support, hyperbilirubinemia, and hypoglycemia.

Results: Among 6426 singleton livebirths between 2014 and 2018, 490 (7.6%) mothers were found to be diabetic during pregnancy. 51% had GDMA1 vs 44% had GDMA2, while pre-GDM accounted for 5% of total. The mean age of the mothers was 32 years and mean BMI 36.1kg/m2, with 77% of them being classified as obese. Preterm births (delivery at gestational age < 37 weeks) was observed in 19% of pre-GDM mothers compared with 8% and 13% in the GDMA 1 and 2 groups respectively. Infants born to mothers with pre-GDM were found to have lower 1-minute APGAR scores, with 23% 1-minute APGAR < 7. There was no  differences in 5 minutes APGAR scores between three groups. A higher proportion of LGA neonates (15%) were born to women with pre-GDM compared to GDMA1 and GDMA2 (10% and 13%). The proportion of hyperbilirubinemia was similar in the three groups. Neonatal hypoglycemia was more in pre-GDM group (34.6%) compared with 13.9% and 23% in the GDMA1 and 2 groups respectively. Infants born to mothers with pre-GDM also had higher rates of respiratory distress at birth requiring respiratory support (27%) as opposed to 15% in other two groups. 
 Conclusion(s): Pre-GDM results in worse neonatal outcomes in our population, especially in women with high BMI. Optimizing maternal glucose control, monitoring weight gain during pregnancy may help alleviate some of these adverse neonatal outcomes.
Adedapo Kiladejo CV - Chronological.pdf