Poster Session 4
Julie Trahan, MD, MSc (she/her/hers)
Maternal-Fetal Medicine Fellow
Columbia University
New York, NY, United States
Qi Yan, PhD
Assistant Professor
Columbia University Irving Medical Center
New York, New York, United States
Noelia Zork, MD
Associate Professor of Obstetrics and Gynecology, Director of the Diabetes in Pregnancy Program
Columbia University Irving Medical Center
New York, NY, United States
Diabetes in pregnancy is associated with an increased risk of cesarean delivery (CD). While CD risk factors among pregnancies with gestational diabetes (GDM) are well defined, such as nulliparity, body mass index, gestational weight gain, and insulin use, it is unclear whether these same risk factors apply to pregnancies with preexisting diabetes. The objective of this study was to identify risk factors for unplanned CD among pregnancies with Type 2 diabetes (T2D) or early GDM.
Study Design: This was a secondary analysis of the Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy (MOMPOD) randomized controlled trial. Participants with T2D or early GDM were included if they had a trial of labor. Baseline and pregnancy characteristics were compared between those with a vaginal delivery (VD) and those with an unplanned CD using descriptive and logistic regression analyses, controlling for potential confounders.
Results:
Of 405 participants, 144 (36%) had an unplanned CD and 261 (64%) had a VD. There were no differences in diabetes type, metformin use, or neonatal birthweight between groups. Compared to those with a VD, participants with an unplanned CD had greater median gestational weight gain [11.6 pounds (interquartile range (IQR) 6.8-15.4) vs. 10 pounds (IQR 4.4-14.9), p=0.019], enrollment HbA1c ≥ 6.5% (69% vs. 56%, p=0.0239), third trimester HbA1c ≥ 6.5% (39% vs. 25%, p=0.0459), and median glucose levels in labor [130.0 mg/dL (IQR 112.0-161.5) vs. 121.0 mg/dL (IQR 100.0-144.0), p=0.0025]. There was no difference in median third trimester HbA1c. In multivariate adjusted analysis, only median enrollment HbA1c (mean gestational age 11.2 weeks) was associated with CD [7.3% for CD vs. 6.85% for VD, p=0.0107; aOR 1.21 (95% confidence interval 1.03, 1.42)].
Conclusion: Higher first trimester HbA1c is associated with CD in patients with T2D or early GDM attempting VD. Preconception counseling should focus on improved glycemic control prior to and in early pregnancy as a potential strategy to reduce risk of unplanned CD for pregnant individuals with preexisting diabetes.
