THE EFFECT OF PARITY ON DIFFERENT PREGNANCY AND NEONATAL ADVERSE OUTCOMES AMONG WOMEN WITH PRE-GESTATIONAL DIABETES

Problem Statement: Pregestational diabetes mellitus (PGDM) is associated with a higher incidence of adverse maternal and neonatal outcomes, compared to the general population. Parity has been shown to affect the risk to several of these adverse outcomes, however, its effect among women with PGDM is not clear. We aimed to assess the effect of parity on different pregnancy and neonatal adverse outcomes, among these women.

Methods: We retrospectively compared between consecutive pregnancies carried by primiparous vs. multiparous women with pregestational type 1 and type 2 diabetes. Pregnancy adverse outcomes included maternal hypertensive complications of pregnancy (HTN complications), cesarean section (C-section) and shoulder dystocia. Neonatal adverse outcomes included large for gestational age (LGA), small for gestational age (SGA), birth weight percentile, clinically significant neonatal hypoglycemia, neonatal jaundice requiring phototherapy and neonatal respiratory complications.

Results: Of 152 pregnancies in 111 women, 98 (64.5%) were carried by multiparous women. Multiparity significantly increased the risk for a LGA neonate (OR 1.07-1.44) and for neonatal hypoglycemia (OR 1.02-1.42), while significantly decreased the risk for maternal HTN complications (OR 0.84-0.99), after adjustment for several possible confounding models. Sensitivity analyses, addressing parity as a categorical variable and assessing the effect of parity in a nested case-control births sample, showed similar trends.

Conclusion: In women with PGDM, multiparity was shown as a risk factor for neonatal adverse outcomes (LGA and neonatal hypoglycemia), while having a protective effect on maternal HTN complications.