Adverse pregnancy outcomes rising with gestational diabetes
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From 2014 to 2020 in the United States, the overall rate of multiple adverse pregnancy outcomes rose for pregnant individuals with gestational diabetes, and rates of specific adverse outcomes varied by race and ethnicity, according to data.
“Population-based studies on racial and ethnic disparities in gestational diabetes have focused on differences in the rate of diagnosis, rather than adverse pregnancy outcomes,” Kartik K. Venkatesh, MD, PhD, assistant professor of obstetrics and gynecology at Ohio State University, and colleagues wrote. “Racial and ethnic differences in adverse pregnancy outcomes in this high-risk population may be modifiable through equitable delivery of evidence-based clinical interventions, which reduce the risk of hyperglycemia-associated complications.”
The researchers sought to determine whether the frequency of adverse pregnancy outcomes among individuals with gestational diabetes in the United States changed over time and whether the risk of these outcomes varied by maternal race and ethnicity.
Maternal outcomes of interest were cesarean delivery; primary cesarean delivery; preeclampsia or gestational hypertension; ICU admission; transfusion; large for gestational age (LGA); macrosomia (>4,000 g at birth); small for gestational age (SGA); preterm birth; and neonatal ICU admission.
For the study, the researchers analyzed data on births from the U.S. National Center for Health Statistics and included 1,560,822 pregnant individuals with gestational diabetes who were aged 15 to 44 years (mean age, 31 years) and had singleton nonanomalous live births from 2014 to 2020. Of these individuals, 1% were American Indian, 13% were Asian/Pacific Islander, 12% were Black, 27% were Hispanic/Latina and 48% were white.
Results indicated a statistically significant increase during the study period in the overall frequency (mean annual percentage change per year) of preeclampsia or gestational hypertension (4.2%; 95% CI, 3.3-5.2), transfusion (8%; 95% CI, 3.8-12.4), preterm birth at less than 37 weeks (0.9%; 95% CI, 0.3-1.5) and neonatal ICU admission (1%; 95% CI, 0.3-1.7). Researchers also reported a significant decrease in cesarean delivery (1.4%; 95% CI, 1.7 to 1.1), primary cesarean delivery (1.2%; 95% CI, 1.5 to 0.9), LGA (2.3%; 95% CI, 2.8 to 1.8) and macrosomia (4.7%; 95% CI, 5.3 to 4).
No significant change was found in maternal ICU admission and SGA.
With the exception of LGA and macrosomia, all assessed outcomes were significantly higher among Black individuals than white. Furthermore, compared with white individuals, American Indian individuals were at significantly elevated risk for all assessed outcomes except cesarean delivery and SGA, and Hispanic/Latina and Asian/Pacific Islander individuals were at significantly elevated risk for maternal ICU admission, preterm birth, neonatal ICU admission and SGA.
“From 2014 through 2020, the frequency of multiple adverse pregnancy outcomes in the U.S. increased among pregnant individuals with gestational diabetes,” Venkatesh and colleagues concluded. “Differences in adverse outcomes by race and ethnicity persisted.”
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