935: Racial/ethnic disparities in glycemic control among women with gestational diabetes: A multiracial pregnancy cohort study

Racial/ethnic disparities in prevalence of gestational diabetes (GDM) are well documented as are disparities in perinatal complications, with minorities at higher risk compared to white women. However, it remains unknown whether glycemic control (GC), the cornerstone of GDM care, varies by race/ethnicity and might thus explain disparities in outcomes. We examined the racial/ethnic disparities in GC among women with GDM. In a retrospective cohort of 27,954 women with GDM at Kaiser Permanente Northern California in 2007-2017, self-monitored blood glucose (SMBG) levels were recorded by a standardized centralized monitoring program. Suboptimal GC was defined as < 80% of SMBG meeting the American Diabetes Association goals (fasting ≤ 95 mg/dL and 1-hr postprandial ≤ 140 mg/dL). Poisson regression models were computed, adjusting for sociodemographic, lifestyle, and GDM severity indicators. Overall, 47.8% of women with GDM had suboptimal GC, with higher levels and lower counts of SMBG at fasting and 1-hr postprandial when compared to women with optimal GC (all P-values < 0.05). Compared to Whites, both Hispanics and Asians/Pacific Islanders had a 4% lower (RR 0.96; 95% CI: 0.93-0.99) and Blacks had an 18% higher (1.18; 1.13-1.24) risk of suboptimal GC, after adjusting for covariates. The racial/ethnic pattern for suboptimal GC varied by fasting vs. 1-hr postprandial. Compared to Whites, Hispanics and Asians/Pacific Islanders had an 11% and 17% lower risk and Blacks had an 11% increased risk of suboptimal GC at fasting, whereas all racial/ethnic minorities had a higher risk (RR: Hispanics 1.16, Asians/Pacific Islanders 1.28, Blacks 1.67) of suboptimal GC at 1-hr postprandial (all P-values < 0.05). Compared to white women with GDM, Hispanics and Asians/Pacific Islanders had better overall and fasting GC and Blacks had worse overall and fasting GC, whereas all racial/ethnic minorities had worse 1-hr postprandial GC. Our findings highlight the need of racial/ethnic tailored GDM care and management, and further study of perinatal outcomes associated with these differences in GC.