Perinatal outcomes among pregnancies with diabetes by rural, suburban, and urban birth location.

Authors

Catharine Leahy, Talia Williams, Sonja Knudson, Katie McLaughlin, Katelyn M Tessier, Lauren A Buckley, Sarah A Wernimont

Published in

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. Volume 39. Issue 1. Pages 2746881. Epub Oct 18, 2026.

Abstract

Rates of perinatal diabetes are increasing, most rapidly in rural communities. There is a gap in knowledge related to how birth location impacts parental and neonatal outcomes in pregnant individuals with diabetes. We assessed differences in clinical outcomes among individuals with perinatal diabetes in rural, suburban and urban settings within a large academic community health system.
This is a retrospective cohort study using an obstetric outcomes database including singleton, non-anomalous pregnancies with Type 1, Type 2 and Gestational Diabetes within a 11-birthing hospital system in 2023. Births were classified as rural, suburban or urban by delivery location. Baseline clinical characteristics and birth outcomes were collected. Our primary outcome was a composite of neonatal respiratory support and hypoglycemia.
A total of 1220 births affected by perinatal diabetes were identified in rural (n = 139), suburban (n = 856), and urban (n = 225) hospitals. There were significant differences in types of diabetes and mode of birth between sites. There were significantly more White individuals in rural settings (p < 0.001). There was no significant difference in the composite outcome of neonatal respiratory support needs and hypoglycemia. However, the odds of neonatal hypoglycemia at suburban hospitals were lower (aOR 0.66 (0.45, 0.98), p = 0.037) than those for rural hospitals after adjustment for diabetes type. This did not lead to a difference in rates of interventions for hypoglycemia, with no significant difference in rate of D10 bolus or dextrose gel use within the first 48 h of life.
There was no difference in the primary composite outcome, but there was a small but statistically significant difference in rates of hypoglycemia at rural compared to suburban sites when adjusting for clinical differences between groups. This did not lead to an increase in need for interventions for hypoglycemia. Overall similar outcomes suggest a potential benefit to shared resources within the same hospital system for management of perinatal diabetes.

PMID:
42893932
Bibliographic data and abstract were imported from PubMed on 19 Oct 2026.

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