1208-P: Modifiable Risk Factors during Pregnancy in Pregestational Diabetes—A 12-Year Analysis

Aim: Pregestational diabetes is associated with adverse outcomes. Preconception care is beneficial but unplanned pregnancy is common. We aimed to determine predictors of outcomes and factors modifiable during pregnancy in women with pregestational diabetes.

Methods: Retrospective analysis of pregnancies complicated by pregestational diabetes at a tertiary center from 2010–2022. Baseline characteristics, longitudinal glycemic, weight and microvascular complication assessment per trimester, and outcomes were collected and binary logistic regression performed.

Results: Of 445 pregnancies, 116 (25%) had type 1 diabetes. Mean age was 32.6 ± 5.8 years with prepregnancy BMI 30.0 ± 7.0 kg/m². The cohort was diverse with 315 (71%) of non-Caucasian ethnicity and 141 (32%) in the most disadvantaged socioeconomic quintile. Planned pregnancy comprised 147 (43%). Women with type 1 compared to type 2 diabetes had increased preeclampsia (28 [26%] vs 48 [15%], p=0.02), preterm (46 [39%] vs 66 [20%], p<0.001), large for gestational age (LGA) (57 [49%] vs 82 [25%], p<0.001), neonatal hypoglycemia (53 [46%] vs 117 [37%], p=0.047), respiratory distress (47 [42%] vs 65 [20%], p<0.001) and neonatal intensive care admission (NICU) (48 [41%] vs 84 [26%], p=0.003). Small for gestational age was more common in type 2 diabetes (5 [4%] vs 32 [10%], p=0.045). Adjusting for diabetes type and baseline features, HbA1c>6.5% in 1^st and >6% in 2^nd and 3^rd trimesters and >15% insulin decrease in 3^rd trimester were associated with preeclampsia, 3^rd trimester HbA1c>6% an independent predictor (OR 4.7) irrespective of 1^st trimester HbA1c. Excessive gestational weight gain (GWG) (OR 3.4) and 3^rd trimester HbA1c>6% (OR 3.6), irrespective of 1^st trimester HbA1c, were independent predictors of LGA. Third trimester HbA1c>6% was associated with NICU (OR 3.7). Conclusion: Type 1 and 2 diabetes have distinct risk profiles for adverse outcomes. Early and late pregnancy glycemic control and GWG are modifiable targets during pregnancy.