PREGNANCY OUTCOMES IN A FIRST NATIONS BIRTH COHORT FOLLOWING IN UTERO EXPOSURE TO TYPE 2 DIABETES: THE NEXT GENERATION STUDY.

Objectives To determine the pregnancy outcomes of a First Nations cohort of women with pre-existing type 2 diabetes. Methods The Next Generation longitudinal study is a Canadian birth cohort of children born to mothers of First Nations heritage with pre-gestational type 2 diabetes. A retrospective review of the medical records for child-mother pairs born within this cohort (1995 and 2015) was performed. Maternal baseline characteristics, pregnancy and delivery information, fetal ultrasound data, and fetal/newborn variables were collected and analyzed descriptively. Results 112 child-mother pairs born between 1995 and 2015 were identified. The median age of mothers in the cohort was 22 and the median 1st trimester HbA1C was 9.3%. Most mothers were overweight or obese at the start of pregnancy. With a median gestational age at delivery of 37 weeks, the Cesarean section (CS) rate of this cohort was 41% and over half of the newborns (55.5%) were macrosomic at birth. The rate of fetal anomalies was 19.6%, with renal abnormalities being the most common (7.1%). The rate of cardiac anomalies was 5.4% and 6% of fetuses had a single umbilical artery. Conclusions This cohort is the first of its kind to examine the impact of pre-gestational diabetes on pregnancy longitudinally in a Canadian First Nations population. The high rates of anomalies, macrosomia and CS provide valuable insights into disease processes in pregnancy for First Nations women with diabetes and possible intrauterine origins of health and disease in their offspring. There is also evidence of opportunity for preconceptional optimization of maternal health.