(1095) Intellectual disability as a risk factor for adverse outcomes among pregnant people with diabetes

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Manasa G. Rao, MD

Resident Physician
Columbia University Medical Center
New York, New York, United States

Coauthor(s)

Timothy Wen, MD, MPH (he/him/his)

Assistant Professor
University of California, San Diego
Irvine, California, United States
Mary E. D'Alton, MD

Obstetrician and Gynecologist-in-Chief Willard C. Rappleye Professor and Chair
Columbia University Medical Center
New York, New York, United States
AF

Alexander M. Friedman, MD, MPH

Professor of Obstetrics and Gynecology
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

Objective: Intellectual and developmental disabilities (IDD) are associated with increased risk of adverse pregnancy outcomes and the proportion of pregnant patients with a IDD diagnosis has increased over time. Diabetes mellitus (DM) requires more intensive antenatal care including frequent glucose monitoring, medication adherence and titration, and frequent visits. It is unclear whether IDD is an independent risk factor for adverse outcomes among pregnancies with DM. The purpose of this analysis was to evaluate whether IDD was associated with adverse outcomes among deliveries complicated by DM.

Study Design: Delivery hospitalizations to patients with pregestational and gestational DM aged 15-54 were analyzed using the 2000-2021 Nationwide Inpatient Sample. The primary exposure of interest was IDD defined using ICD9/ICD10 codes. Temporal trends in proportion of deliveries with IDD and DM were analyzed with joint point regression to determine average annual percent change (AAPC) with 95% confidence intervals. The association between hospital, demographic, and a range of adverse outcomes were analyzed with logistic regression models.

Results: 2389 (0.04%) deliveries of 6,012,324 with DM diagnosis had an associated IDD diagnosis. Deliveries to patients with both DM and IDD increased from 2 per 10,000 in 2000 to 7 per 10,000 in 2021 (AAPC 7.8, 6.4-10.3, p< 0.01). More patients with IDD had pregestational DM (30.2% vs 13.5%). In adjusted analyses, patients with IDD had increased odds of diabetic ketoacidosis (aOR 2.66, 1.06-6.69), preterm birth < 37 weeks (aOR 1.46, 1.10-1.92), cesarean delivery (aOR 1.30, 1.05-1.60), non-transfusion severe maternal morbidity (aOR 2.06, 1.26-3.32), hypertensive disorders of pregnancy (aOR 1.29, 1.03-1.63), and stillbirth (aOR 1.94, 1.07-3.5). Odds of shoulder dystocia did not differ between the groups.

Conclusion:

Among deliveries with DM, the proportion of IDD increased over time. IDD is associated with increased risk of adverse outcomes among deliveries with DM. Additional resources and surveillance may be warranted for patients with IDD and DM to optimize outcomes.