7833 Gestational Diabetes Mellitus (GDM): A Weighted Spectrum of Clinical Outcomes
Authors: Moazzami Mitra , Venkatesan Nanditha , Rajagopalan Kamalnath Sankaran , Vella Adrian V , Egan Aoife 
Published: October 2024

Abstract
Disclosure: M. Moazzami: None. N. Venkatesan: None. K.S. Rajagopalan: None. A.V. Vella: None. A. Egan: None.
Gestational diabetes mellitus (GDM) affects approximately 10% of pregnancies, with rates almost doubling in minority subgroups. Higher body mass index (BMI) is a significant GDM risk factor, and BMI ≥ 25kg/m2 is often used as a criterion in risk factor-based screening programs. However, up to 60% of individuals with GDM have a normal BMI, and it is unclear if this offers protection against associated adverse outcomes. Furthermore, many prior studies fail to address the fact that those of Asian descent require a lower BMI cut-off, given their different distribution of body fat. Our study evaluated GDM pregnancy outcomes using BMI as a risk indicator. We compared individuals with BMIs &lt; 25 kg/m2, 25-30 kg/m2, and &gt; 30 kg/m2. For individuals that self-identified as Asian, we adjusted BMI categories: &lt;23 kg/m2 for normal weight, 23-30 kg/m2 for overweight, and &gt;30 kg/m2 for obese. We identified 2212 subjects diagnosed with GDM via universal screening and Carpenter and Coustan criteria at our institution from 2018 - 22. In total, 508 (23.0%) were normal weight, 611 (27.6%) overweight, and 1093 (49.4%) obese. The average maternal age was 31 years. Higher proportions identified as Hispanic and non-White race in overweight and obese categories. Maternal adverse outcomes were higher in obese compared to overweight or normal BMI categories (cesarian delivery: normal 26.7 v overweight 28.3 v obese 22.7%, p&lt;0.001; hypertensive disorders: normal 13.2 v overweight 12.5 v obese 22.7%, p &lt;0.001). Pharmacological therapy was required in 50% with obesity versus 24.8% in normal, and 28.7% in overweight categories (p&lt;0.001). While there were no differences in live birth rates across categories, infants born to mothers with obesity had a higher birthweight (normal 3.30 v overweight 3.38 v obese 3.45kg, p&lt;0.001) and were more likely to have neonatal hypoglycemia (normal 28.7 v overweight 25.5 v obese 43.8%, p&lt;0.001) and require intensive care unit admission (normal 8.4 v overweight 5.5 v obese 12.7%, p&lt;0.001). Attendance at postpartum glucose testing varied across BMI categories with lower attendance in mothers with obesity followed by normal weight BMI (normal 40.75 v overweight 45.99 v obese 36.2%, p&lt;0.001). Compared to overweight individuals, those with normal weight exhibited higher rates of postpartum glucose intolerance (12.4 v 6.9%, p =0.002). However, those with obesity had the highest rates of glucose intolerance (20.7%, p&lt;0.0002). Individuals with normal weight had the highest rates of breastfeeding (normal 95.9 v overweight 92.8 v obese 91.4% p=0.006). This study highlights the nuanced relationship between BMI and pregnancy outcomes in GDM. While maternal obesity was associated with the poorest outcomes, those with normal BMI were not protected compared to overweight individuals, and experience higher rates of postpartum glucose intolerance.
Presentation: 6/2/2024