(194) Do lower glycemic targets improve outcomes in one-step diagnosed gestational diabetic pregnancies

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Assess if using lower glycemic targets (fasting 85, 2h post-prandial 120) will improve outcomes, such as large for gestational age infants and c-section rate, in GDM patients diagnosed with the 1-step approach.

Study Design: Retrospective cohort study of GDM pregnancies diagnosed with the 1-step approach who delivered at University of Kansas Medical Center between Sep 2016 - Mar 2022. Exclusions were preexisting diabetes, HgbA1c > 6.5, multiple gestations, significant coexisting chronic conditions, fetal anomalies, and patients who had a mixture of therapeutic glycemic targets. Continuous variables were compared by T-tests and categorical variables by Chi-squared or Z-test. Multivariable linear regression was performed using SPSS Statistics (IBM).

Results: The study population consisted of 504 patients in the low glycemic target group of (85/100) and 187 patients in the higher glycemic target group of (95/120). The lower glycemic target group had a lower weight (200 vs 211, p 0.01) and used oral medication more often (94% vs 88%, p 0.01). The lower glycemic target group was found to have a lower C-section rate (31% vs 41%, p-value 0.02) and higher neonatal hypoglycemia (36% vs 24%, p < 0.01). After adjustment, only neonatal hypoglycemia remained significantly different (RR +12%, p 0.01). The p-value for c-section increased to 0.58 from 0.02.

Conclusion: These data demonstrate that a lower glycemic target among GDM pregnancies diagnosed with the one-step approach might increase the risk for neonatal hypoglycemia. Cesarean rate is possibly lower, but this result needs to be investigated further.

Primary & Presenting Author(s)

Hannah Coggeshall, BS (she/her/hers)
The University of Kansas School of Medicine
Kansas City, Kansas, United States

Coauthor(s)

JB
Juliana Bakk, MD
The University of Kansas Medical Center
Kansas City, Kansas, United States
GL
Gene Lee, MD
Assistant Professor, Maternal Fetal Medicine
KUMC
KUMC, Kansas, United States