SAT-522 - Multidisciplinary Care for Diabetes in Pregnancy: Methodology for Evaluating Outcomes and Trends Toward Improvement

Introduction: Diabetes in pregnancy is associated with significant maternal and neonatal morbidity and requires specialized care. Professional societies recommend multidisciplinary management; however, real-world data comparing multidisciplinary care with standard care are limited. A framework to evaluate these models is needed to validate and support such programs. This study assesses the impact of a multidisciplinary clinic with endocrinology, maternal-fetal medicine, certified diabetes educators and registered dieticians on obstetric and neonatal outcomes in pregnant people with diabetes at a large academic medical center.

Methods: This retrospective study compared patients receiving prenatal care through the University of Chicago Diabetes in Pregnancy Program (DIPP intervention cohort, n=33) from April 2020- September 2021 with a historical control group (n=302) who received prenatal care at the University of Chicago from November 2018- March 2020. Propensity score matching was performed using XLSTAT to adjust for age, race, ethnicity, and diabetes type (1:3 ratio), followed by matching on first-trimester BMI and A1C (1:2 ratio). The final cohorts included 32 intervention and 64 control patients. Maternal and neonatal outcomes were extracted from the EPIC electronic medical record. T-tests and chi-square tests were used to assess differences between groups.

Results: Baseline distributions of age, race, ethnicity, and diabetes type were similar between the intervention and control groups, with no statistically significant differences (all p-values > 0.05). The study cohort (intervention + control) was predominantly Black (62%), followed by White (19%), with 24% identifying as Hispanic or Latino. 66.67% of participants were aged 31–39 years. 49% of participants had Type 2 diabetes, 44% had Gestational diabetes, and 7% had Type 1 diabetes. Mean gestational age at delivery and birth weight were similar between groups (DIPP: 36.71weeks; control: 36.48weeks; p=0.34 and DIPP: 3033.91g; control: 3090.25g). There was a trend toward lower rates of preterm birth ( < 37 weeks) in DIPP neonates compared to controls (31.25%versus 40.63%) though the difference was not statistically significant (p=0.371). There was also a trend toward lower rates of Cesarean in the DIPP group (40.63% vs. 57.81% p=0.112).
Mean HbA1c reduction during prenatal care were similar in the DIPP group (−1.33 ± 1.60) and in controls (−1.17 ± 1.70, p=0.38). NICU admission rates were also similar between groups.

Discussion: Prenatal care from a combined endocrine and obstetric clinic was associated with favorable trends in preterm birth, and cesarean delivery, though the differences did not reach statistical significance. This methodology can be applied to larger sample sizes to better evaluate the impact that multidisciplinary care models have on obstetric and neonatal outcomes.

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