1388-P: Maternal and Neonatal Outcomes in Pregnancies with Preexisting Type 1 Diabetes and Controls
Authors: KAUR RAVINDER JEET , RIZVI SHAFAQ RAZA , TRINIDAD MARI CHARISSE , SMITH BYRON H. , BATTHULA SREEDHAR , MCCRADY-SPITZER SHELLY K. , REID COREY , DESJARDINS DONNA , O’MALLEY GRENYE , CASTORINO KRISTIN N. , PINSKER JORDAN E. , KREMERS WALTER K. , DASSAU EYAL , LEVY CAROL J. , KUDVA YOGISH C. 
Published: June 2020

Background: There are limited contemporaneous data about outcomes in pregnancies with pre-existing type 1 diabetes (T1D) in the U.S.

Objective: To determine maternal and neonatal outcomes in pregnancies with preexisting T1D and pregnancies in age, parity and BMI matched healthy subjects.

Methods: We retrospectively studied 32 pregnancies in patients with preexisting T1D matched for age (mean 25.83 years), gravidity/parity {G1P1 (66), G2P1 (19), G3P1 (9) and G4P1 (6) % respectively} and BMI with controls (n=32) during a 5 year period from 01/01/2015 at Mayo Clinic, Rochester.

Results: In 32 T1D pregnancies, 4 (12.5%) congenital defects (CD) were observed in neonates, 1-dysplastic ribs with thumb hypoplasia and 3-congentinal heart defects leading to death in one in comparison to no congenital defect or death in controls. CD pregnancies were complicated by severe pre-eclampsia in all 4 and poor glycemic control (HbA1c &gt;8) in 3. There was a significant difference in Apgar score at 1 min between T1D pregnancies and controls (p=&lt;0.001). Significant respiratory distress was observed in neonates with T1D pregnancies (p=0.011) compared to control group. Significant difference was observed in gestational age b/w two groups (35.9 ± 3.1 vs. 39.4 ± 1.4, p=&lt;0.001). More severe eclampsia was observed in T1D subjects (11 vs. 2, p=0.005) along with pre-term deliveries (12 vs. 1, p=&lt;0.001) compared to controls. Frequency of C-sections was increased in T1D subjects (19 vs.3, p=&lt;0.001) compared to controls. Smoking had a significant effect on Apgar score at 5 min (p=0.014) when compared with current smokers or former smokers. Hypothyroidism (being on T4) during pregnancy had an effect on Apgar score both at 1 min (p=0.003) as well as at 5 min (p=0.004).

Conclusion: Pregnancies in T1D continue to be high risk pregnancies and need tight glycemic control with a more advanced system such as closed loop insulin delivery during pregnancy to improve maternal and neonatal outcomes.

Disclosure

R. Kaur: None. S. Rizvi: None. M. Trinidad: None. B.H. Smith: None. S. Batthula: None. S.K. McCrady-Spitzer: None. C. Reid: None. D. Desjardins: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. J.E. Pinsker: Advisory Panel; Self; Medtronic. Consultant; Self; Eli Lilly and Company, Tandem Diabetes Care. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Tandem Diabetes Care. Speaker’s Bureau; Self; Tandem Diabetes Care. W.K. Kremers: Research Support; Self; AstraZeneca. E. Dassau: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Roche Diabetes Care. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.