Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Impact of Obesity on Pregnancy Outcomes in People with T2DM vs T1DM: A Retrospective Cohort Study (#144)

Xi May Zhen 1 2 , Jencia Wong 2 , Amanda Gauld 2 , Stephanie Noonan 2 , Maria Constantino 2 , Arianne Sweeting 2 , Anna-Jane Harding 2 , Adam Mackie 3 , Hend Chatila 3 , Margaret McGill 2 , Ted Wu 2 , Glynis Ross 2
  1. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  2. Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Women's and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia

In the context of rising rates of obesity in children/youth, the prevalence of type 2 diabetes mellitus onset in youth/young adults (YT2DM) has surpassed that of type 1 diabetes mellitus (T1DM) in many regions.1 YT2DM is now recognised as a more severe diabetes phenotype, with higher BMI, worse glycaemia, and early and rapid progression of macrovascular and microvascular complications , when compared to T2DM onset later in life.2-6 In people with YT2DM, cardiometabolic risk factors manifest earlier, and there is heightened insulin resistance, higher metformin failure rates, and accelerated deterioration in beta-cell function when compared to usual T2DM.2-6 We have shown that diabetes-related complications and mortality are more prevalent and occur earlier amongst those with YT2DM compared with T1DM, but are frequent in both groups.5 People with YT2DM have an excess of long term renal complications compared to T1DM and a higher risk for retinopathy than older-onset T2DM.5,6

Contemporaneously, overweight and obesity are also increasingly common in people with T1DM, affecting ~50% of people with T1DM in our clinics which is consistent with published data7. Obesity is the most common health condition in women of reproductive age.8 Maternal obesity is associated with worse pregnancy outcomes in women with T2DM but there is limited data in people with T1DM.9, 10 This project aims to explore the impact of obesity on pregnancy outcomes in women with T1DM compared to YT2DM. We will present a retrospective analysis of prospectively collected pregnancy data (2010-2019) from women with T1DM/T2DM who were managed at and gave birth at Royal Prince Alfred Hospital, Sydney. This project will present much-needed local data from an Australian tertiary centre on the impact of overweight/obesity on pregnancy outcomes in women with T1DM vs YT2DM. Analysis of preliminary data showed that women with T2DM (n=66), when compared with women with T1DM (n=55), were older, and had shorter diabetes-duration, higher pre-pregnancy BMI (33.8±7.6 vs 25.7±5.3kg/m2), and higher 1st-trimester gestational weight-gain (p≤0.002 for all). Despite similar mean pregnancy HbA1c and less favourable maternal weight indices, the offspring of women with T2DM had lower mean birth-weight centiles, and lower incidences of LGA babies and NICU admission. However, pre-eclampsia and congenital malformations appeared to be more frequent in T2DM pregnancies. Overall, adverse pregnancy outcomes were high for women with both types of diabetes, but there appeared to be a difference in the types of adverse outcomes seen in women with T2DM compared to those with T1DM.