(885) Factors associated with delivery at <39 weeks for “poor glucose control” in perinatal diabetes

ACOG guidelines recommend delivery in the 39^th week of pregnancy for patients with pre-gestational and medication-controlled gestational diabetes but allow for consideration of delivery < 39 weeks in the setting of “poorly controlled” diabetes. Unfortunately, “poor control” is not explicitly defined. We examined diabetes-related criteria that clinicians use to justify early delivery.

Study Design:

This is a descriptive analysis of all pregnancies with diabetes from 2011-2021 within a multi-institution health system. Patients delivering < 39 weeks with only a diabetes-related indication for delivery were identified. Any reported glucose values for those patients were reviewed. For the purposes of this study, we pragmatically defined “poor glucose control” as >50% of recorded glucose values within two weeks prior to delivery outside of the expected range. Hemoglobin A1C (HbA1c) within 3 months of delivery was also identified. We assessed clinician rationale for delivery via review of notes at or before hospital admission. Chi-square and Fisher’s exact tests were used for statistical analyses.

Results:

We identified 4750 patients with perinatal diabetes: 287 patients delivered at < 39 weeks for a diabetes-related indication. 32% had a HbA1c within 3 months of delivery with median values of 7.2%, 5.9%, and 5.8% for patients delivering at 36, 37 and 38 weeks, respectively. 61% had glucose values documented in the medical record: just 21% of patients met our pragmatic definition of “poor glucose control”. However, 71% were described by a provider as having “poor glucose control” and underwent early delivery solely for this reason. The next most common indications for early delivery were “recommendation by a Maternal Fetal Medicine specialist” (39%) and “suspected fetal macrosomia” (28%). 21% had ≥3 factors listed as delivery indications (Table 1).

Conclusion:

Overall, little objective data underlies clinicians’ decision to recommend early delivery for “poor glucose control”. Additional guidelines are urgently needed to objectively define “poor control” and standardize delivery recommendations.