1233-P: Early Intervention in Pregnant Women with Preconception History of Glucose Intolerance

Introduction: Diabetes in pregnancy is associated with greater risks. Previous studies focused on early screening of women with variety of risks for gestational diabetes mellitus (GDM), this study focused on women with preconception history of prediabetes or GDM.

Methods: A retrospective query of the electronic health record was conducted to identify deliveries of women with preconception prediabetes or GDM 1/1/2018 - 10/30/2022 at 4 large centers of Sutter Health in Northern California. Patients with history of diabetes were excluded. Primary aim was to assess characteristics of deliveries underwent early (≤20 weeks) vs standard of care intervention (>20 w) for GDM. Secondary aim was to compare pregnancy outcomes between the groups. Early intervention was defined as any of the following that was done ≤20 weeks: glucose tolerance test, prescriptions related to diabetes, referrals for diabetes management.

Results: Total of 1,954 birth deliveries included, 622 (32%) underwent early, 1,332 (68%) had standard intervention. Women in early group were older (35.8±4.1 vs 35.25±4.4, p=0.01), heavier (preconception BMI 29.3±6.5 vs 26.6±5.9, p<0.001), had higher preconception HbA1c (5.5±0.3 vs 5.3±0.3, p <0.001), and higher first trimester HbA1c (5.6±0.5 vs 5.2±0.2, p <0.001). There were no statistically significant differences (p>0.05) between the early and standard for eclampsia, small for gestation (SGA), macrosomia, neonatal hypoglycemia, shoulder dystocia, preterm delivery, NICU admissions, neonatal respiratory distress syndrome. C-section was higher (p=0.002) in early group. Those started on medication early had higher rate of SGA (p=0.003) and neonatal hypoglycemia (p=0.01).

Conclusion: This study showed majority of women with preconception glucose intolerance undergo standard screening for GDM during pregnancy. Although no differences found in most of the maternal fetal outcomes between the groups, women started on medication early had higher SGA and neonatal hypoglycemia.