Frequency of Adverse Pregnancy Outcomes Saw Increase Among Patients with Gestational Diabetes

Kartik K. Venkatesh, MD, PhD

The frequency of multiple adverse pregnancy outcomes in the United States increased among pregnant individuals with gestational diabetes from 2014 through 2020, according to new findings.

Data show a statistically significant increase in the overall frequency of preeclampsia or gestational hypertension (4.2% [95% CI, 3.3% to 5.2%]), transfusion (8.0% [95% CI, 3.8% to 12.4%]), preterm birth at <37 weeks (0.9% [95% CI, 0.3% to 1.5%]), and admission to the neonatal ICU (1.0% [95% CI, 0.3% to 1.7%]).

“The current analysis, which was focused on pregnancy outcomes, builds on a recent publication using US vital statistics between 2011 and 2019 that found the prevalence of gestational diabetes was increasing among all race and ethnicity subgroups and in all age groups, but more so among Asian/Pacific Islander and Hispanic/Latina subgroups relative to White individuals,” wrote study author Kartik K. Venkatesh, MD, PhD, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University.

Data from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) Natality Files from 2014 - 2020 was collected and used in a serial cross-sectional descriptive study design.

Investigators compared pregnancy outcomes among non-Hispanic American Indian, non-Hispanic Asian/Pacific Islander, non-Hispanic Black, and Hispanic/Latina with non-Hispanic White individuals (reference group) with gestational diabetes. They excluded individuals younger than 15 or older than 44 years.

The adverse pregnancy outcomes of interest included maternal outcomes (any cesarean delivery, primary cesarean delivery, gestational hypertension or preeclampsia, ICU admission, and transfusion) and neonatal outcomes (large for gestational age, small for gestational age, macrosomia, any preterm birth, and NICU admission).

In order to describe the change in rates of adverse outcomes over time overall and by racial and ethnic subgroups, investigators calculated the mean or average annual percentage change (APC).

The final sample in the current study included 1,560,822 of 1,607,216 singleton, non anomalous live births (97%) to individuals with gestational diabetes (median age, 31 years). Data show 1% with American Indian, 13% Asian/Pacific Islander, 12% Black, 27% Hispanic/Latina, and 48% were White.

During the study period, the overall frequency of preeclampsia or gestational hypertension, maternal transfusion, preterm birth at <37 weeks, and NICU admission saw a significant increase.

However, the frequency of cesarean delivery significantly decreased from 416.1 (95% CI, 413.9 to 418.3) to 397.6 (95% CI, 395.8 to 399.5) per 1000 live births, with a mean APC of -1.4% (95% CI, -1.7% to -1.1%).

Other significant decreases were seen in primary cesarean delivery (mean APC, -1.2% [95% CI, -1.5% to -0.9%) and macrosomia (mean APC, -4.7% [95% CI, -5.3% to -4.0%). Data show the frequency and rate of maternal ICU admission did not significantly change in the study period.

Investigators observed Black individuals had significantly increased risk of most assessed adverse pregnancy outcomes, but had a significantly lower risk of large for gestational age (LGA) and macrosomia. American Indian patients were at a significantly increased risk of the assessed outcomes, except cesarean delivery and SGA.

Additionally, Hispanic/Latina individuals were at significantly increased risk of cesarean delivery, primary cesarean delivery, maternal ICU admission, SGA, preterm birth, and NICU admission, but had a significantly lower risk of preeclampsia or gestational hypertension, LGA, and macrosomia.

Investigators noted the observed racial and ethnic disparities in the risk of adverse outcomes persisted from 2014 - 2020.

The study, “Risk of Adverse Pregnancy Outcomes Among Pregnant Individuals With Gestational Diabetes by Race and Ethnicity in the United States, 2014-2020,” was published in JAMA.