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    Trends in Screening for Diabetes in Early Pregnancy in the United States

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    Authors
    Wilkie, Gianna L.
    Faculty Advisor
    Anthony Nunes
    Academic Program
    Master of Science in Clinical Investigation
    UMass Chan Affiliations
    Department of Obstetrics and Gynecology
    Document Type
    Master's Thesis
    Publication Date
    2021-12-23
    Keywords
    pregnancy
    diabetes screening
    perinatal outcomes
    Endocrinology, Diabetes, and Metabolism
    Obstetrics and Gynecology
    
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    Abstract
    Objective: To characterize current diabetes screening practices in the first trimester of pregnancy in the United States, evaluate patient characteristics and risk factors associated with early diabetes screening, and compare perinatal outcomes by early diabetes screening. Methods: This was a retrospective cohort study of US medical claims data from patients diagnosed with a viable intrauterine pregnancy who presented for care before 14 weeks of gestation without pre-existing pre-gestational diabetes from the IBM MarketScan® database for the period of January 1, 2016, to December 31, 2018. Univariate and multivariate analyses were used to evaluate clinical factors and perinatal outcomes. Results: There were 400,588 pregnancies identified as eligible for inclusion, with 18.0% of women receiving early screening for diabetes. Of those with laboratory order claims, 53.1% had hemoglobin A1c, 30.0% fasting glucose, and 16.9% oral glucose tolerance tests. Compared to women who did not have early diabetes screening, those that did were more likely to be older, obese, have a history of gestational diabetes, chronic hypertension, polycystic ovarian syndrome, hyperlipidemia, and a family history of diabetes. In adjusted logistic regression, history of gestational diabetes (aOR 3.99, 95% CI 3.73-4.26) had the strongest association with early diabetes screening. Early diabetes screening irrespective of the screening result was also associated with adverse perinatal outcomes including a higher rate of cesarean delivery, preterm delivery, gestational hypertension, pre-eclampsia, and gestational diabetes. Conclusion: First trimester early diabetes screening was mostly commonly performed by hemoglobin A1c evaluation, and women that underwent early diabetes screening regardless of the result were more likely to experience adverse perinatal outcomes.
    DOI
    10.13028/n507-gm23
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/31397
    Rights
    Copyright is held by the author, with all rights reserved.
    ae974a485f413a2113503eed53cd6c53
    10.13028/n507-gm23
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    Morningside Graduate School of Biomedical Sciences Dissertations and Theses

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