MON-565 - Glycemic Control during Pregnancy by Diabetes Type Among Women in Puerto Rico: A Retrospective Study

Introduction:
Diabetes mellitus (DM) during pregnancy is associated with adverse maternal and perinatal outcomes. Puerto Rico has one of the highest diabetes prevalences in the United States estimated at 13.6% for 2017–2020. However, data describing glycemic patterns among pregnant women by DM type remain limited. This study examined differences in hemoglobin A1c (HbA1c) levels across DM types and assessed factors associated with glycemic control during pregnancy.

Methods:
A retrospective analysis of 153 pregnant women with diabetes who delivered at a tertiary hospital in Puerto Rico was conducted, including women with gestational diabetes mellitus (GDM), type 1 diabetes mellitus (T1DM), and type 2 diabetes mellitus (T2DM). HbA1c measurements obtained during pregnancy were cleaned and the maximum HbA1c recorded across trimesters was used as the primary exposure. Multivariable linear regression was performed to evaluate associations between HbA1c levels and maternal age, baseline body mass index (BMI), gestational weight gain (GWG), and diabetes type.

Results:
Mean HbA1c levels differed markedly by diabetes type. Women with GDM had the lowest mean HbA1c (5.54 ± 0.77%), followed by women with T2DM (6.96 ± 1.75%), while women with T1DM exhibited the highest levels (8.50 ± 1.53%). In adjusted linear regression models, greater gestational weight gain was significantly associated with higher HbA1c levels (β = 0.017, p = 0.004). Compared with women with GDM, HbA1c levels were significantly higher among women with T1DM (β = 2.79, p < 0.001) and T2DM (β = 1.31, p < 0.001). Maternal age demonstrated a modest inverse association with HbA1c that did not reach statistical significance, and baseline BMI was not independently associated with HbA1c levels.

Conclusion:
Glycemic control during pregnancy varies substantially by diabetes type among women in Puerto Rico, with the highest HbA1c levels observed among those with T1DM. Gestational weight gain emerged as an independent correlate of higher HbA1c, highlighting the importance of weight management alongside glucose monitoring in diabetic pregnancies. These findings underscore the need for tailored glycemic management strategies by diabetes type to optimize maternal outcomes.

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