1247-P: Outcomes of Pregnancies Complicated by Type 1 Diabetes in a Diverse Patient Population at an Urban Diabetes Center

T1D is associated with increased risk of adverse pregnancy outcomes, which can be mitigated by tight glycemic control. There is a paucity of data demonstrating the outcomes of diverse populations of pregnant women with T1D utilizing current diabetes technology. Here we describe the outcomes of 129 pregnancies in 118 women with T1D who delivered between January 2019 and December 2022, managed by a multidisciplinary diabetes care team at a single center. Of this cohort, 42% identified as non-Hispanic white (NHW), 6% as non-Hispanic Black (NHB), 34% as Hispanic, and 5% as Asian or other; 39% were publicly insured. Insulin pumps were used in 67% of pregnancies, CGMs in 90%, and hybrid closed-loop systems in 38%. The median of the average HbA1c through pregnancy in the entire cohort was 6.0%. Preeclampsia occurred in 28% of pregnancies, preterm delivery (<36 weeks) in 25%, macrosomia in 10%, neonatal hypoglycemia in 13%, NICU admission in 28%, and fetal anomalies in 3%. There were no neonatal deaths. Compared to multiple daily injections, insulin pump use was associated with lower average A1c through pregnancy (median 5.8% vs 6.8%, p<0.001) and lower risk of preterm delivery (21% vs 42%, p=0.03). NHB and Hispanic women had higher average A1c compared to NHW women (respectively median 6.6% and 6.5% vs 5.6%, p<0.001), higher risk of preterm delivery (43% and 48% vs 10%, p=0.001), and neonates with lower birthweight (median 3035g and 3215g vs 3465g, p=0.005). Similar trends of higher risk of adverse outcomes were observed in publicly insured women compared to those with private insurance. Our data demonstrates the feasibility of achieving glycemic targets on a population level in pregnant women with T1D. Concerns remain regarding disparities in outcomes between NHB and Hispanic women compared to NHW women and in those with public vs private insurance. Analyses of larger populations are needed to further delineate these disparities and inform systems-level approaches to care of pregnant women with T1D.