Persistent Adverse Perinatal Outcomes among Pregnancies with Gestational Diabetes in the United States

This study aimed 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. We analyzed linked U.S. birth and infant death datasets for singleton, non-anomalous births delivered between 23^0/7 and 42^6/7 weeks' gestation from 2014 to 2022. Multivariate Poisson regression models estimated the independent association between GDM and LGA, small for gestational age (SGA), or HDP. 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% confidence interval [CI] 0.82-0.84; rate difference - 3.06%) without an increase in rates of SGA infants. However, the overall frequency of LGA among pregnancies complicated by GDM was higher than in pregnancies that were not complicated by GDM in the United States 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 (adjusted RR [aRR] 1.34 [95% CI 1.33-1.34]) and HDP (aRR 1.67 [1.66-1.68]). While universal GDM screening and current management strategies have reduced LGA at the population level, LGA still remains persistently higher than in non-GDM pregnancies, and HDP rates continue to rise. Future studies should focus on innovative interventions to improve outcomes. · Rates of GDM and HDP are increasing annually.. · Despite a decrease in LGA since universal GDM screening, rates remain elevated.. · Rates of hypertensive disorders are higher in GDM, similarly in each body mass index class..