Association between diabetes mellitus and fetal and maternal outcomes during and after pregnancy-a nationwide study

Introduction: Diabetes Mellitus (DM) affects both the mother and fetus during and after pregnancy. Multiple studies have shown the prognostic impact of DM on maternal and fetal outcomes, but studies at the national level are limited. Therefore, we aimed to conduct this nationwide study.

Materials and methods: This retrospective study used a Nationwide Inpatient Sample 2020 (NIS) using International Classification of Diseases (ICD-10) codes for adult pregnant patients. STATA version MP14.2 was used mainly for analysis. We used Fischer's exact test to compare proportions, the student's t-test to compare continuous variables, and multivariate regression analysis to calculate the adjusted odds ratio.

Results: The total number of pregnant patients included in the study was 3 436 671; 36 350 (1.05%) had DM. Patients with DM had longer hospital lengths of stay than non-diabetic patients (3.93 days vs. 2.5 days, P < .01). Other significant outcomes were higher cost of hospital stay ($37 079 vs. $23 371, P < .01), preeclampsia (7.17% vs. 2.02%, P < .01), intrauterine fetal death (0.63% vs. 0.13%, P < .01), stillbirth (2.89% vs. 0.75%, P < .01), gestational hypertension (7.07% vs. 3.07%, P < .01) and preterm labor (5.8% vs. 1.94%, P < .01). There were no differences in the two groups regarding pre-existing hypertension, abortion, large for gestational age, eclampsia, placenta previa, abruptio placenta, postpartum anemia, prolonged labor, intrapartum, and postpartum hemorrhage. We conducted a trend analysis from 2016 to 2020 for mortality, length of stay, total charges, and significant maternal and fetal outcomes.

Conclusion: DM is associated with greater maternal and fetal adverse outcomes, resource utilization, and length of stay.