Persistent adverse perinatal outcomes among pregnancies with gestational diabetes in the U.S.

Objectives: To evaluate the prevalence of large-for-gestational-age (LGA) births and hypertensive disorders of pregnancy (HDP) among pregnant individuals with gestational diabetes mellitus (GDM) following the 2014 U.S. Preventive Services Task Force (USPSTF) universal screening recommendation Study Design: We analyzed linked U.S. birth and infant death datasets for singleton, non-anomalous births delivered between 230/7 and 426/7 weeks’ gestation from 2014–2022. Multivariate Poisson regression models estimated the independent association between GDM and LGA, SGA or HDP. Results: Among the 31,791,459 total births included in the analysis, 6.8% had GDM and the LGA prevalence declined from 17.9% in 2014 to 14.9% in 2022 (risk ratio [RR] 0.83; 95% CI 0.82–0.84; rate difference −3.06%) without an increase in rates of small-for-gestational age infants (SGA). However, the overall frequency of LGA among pregnancies complicated by GDM were higher than pregnancies that were not complicated by GDM in the U.S. during this study period ([GDM] 16.2% vs. [non-GDM] 10.8%, P <0.001; RR 1.53 [95% CI 1.52-1.54]). In contrast, HDP prevalence increased from 11.1% to 15.5% during the same period among pregnancies complicated by GDM (RR 1.40; 95% CI 1.38–1.42; rate difference 4.46%). GDM remained independently associated with LGA (aRR 1.34 [95% CI 1.33-1.34]) and HDP (aRR 1.67 [1.66-1.68]). Conclusion: While universal GDM screening and current management strategies have reduced LGA at the population level, LGA still remains persistently higher than non-GDM pregnancies and HDP rates continue to rise. Future studies should focus on innovative interventions to improve outcomes.