Objective: Women with diabetes who have unplanned pregnancies are more likely to have poor glycemic control in early pregnancy which is associated with poor maternal and fetal outcomes. We assessed the prevalence, predictors, and consequences of unplanned pregnancy among women with preexisting diabetes.

Methods: We used EHR data of 486 women aged 18-49 with preexisting type 1 or 2 diabetes who received pregnancy care at a university hospital in North Carolina between 10/2015 and 02/2020. The outcome was unplanned pregnancy while the predictors were maternal demographic, socioeconomic, and health factors. The consequences assessed were maternal infection, cesarean delivery, postpartum contraception, preterm delivery, NICU admission, macrosomia, LBW, fetal abnormality, and fetal death. We estimated statistical associations as odds ratios (OR) and 95% confidence intervals (CI) .

Results: Of the 554 pregnancies that occurred in the sample, 32% were documented as unplanned, 25% as planned, and 43% had no documented intention. The predictors of unplanned pregnancy were age younger than 25 (OR 2.7; CI 1.5-5.0) , African American race (OR 2.7; CI 1.6-4.5) , being single (OR 1.9; CI 1.3-2.9) , having 2+ comorbidities (OR 2.1; CI 1.2-3.7) , and having 3+ previous pregnancies (OR 2.1; CI 1.2-3.9) . Adjusting for maternal factors including early pregnancy HbA1c, unplanned pregnancy increased the odds of macrosomia (OR 2.2; CI 1.2-4.2) and fetal death (OR 1.8; 95% CI 1.1-3.0) , but not maternal infection, cesarean delivery, preterm delivery, NICU admission, LBW, or fetal abnormality. Women with unplanned pregnancies were more likely to receive postpartum contraception (OR 1.7; CI 1.1-2.6) .

Conclusion: Unplanned pregnancies remain common among women with preexisting diabetes and are associated with adverse pregnancy outcomes independent of maternal HbA1c at the start of the pregnancy. Further efforts are needed to expand preconception care and support pregnancy planning in these women.


C.C.Okigbo: None. C.Mclaughlin: None. M.Kirkman: Research Support; Bayer AG, Novo Nordisk.


Society of Family Planning Research Fund (SFPRF13-ES12)

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