814: White's classification of diabetic pregnancies in the 21st century: Is it still valid?

White′s Classification system (WCS) was created almost 60 years ago to identify diabetic (DM) pregnancies at increased risk for perinatal morbidity and mortality. Our objective was to assess the utility of WCS to predict adverse pregnancy outcome in contemporary DM pregnancies. All singleton DM pregnancies delivered > 20 weeks at a single institution over one year (6/2007-5/2008) were reviewed. Factors including maternal age, race, parity, maternal BMI, Type I vs. Type II DM, and vascular disease were retrieved from medical records. Perinatal outcomes were compared based on WCS. Adverse pregnancy outcome (APO) was the primary composite outcome defined as any of the following: IUFD, PTB <34 weeks, severe preeclampsia, shoulder dystocia, and neonatal respiratory disease (need for mechanical ventilation, CPAP > 2 hours, or oxygen > 4 hours). We studied 196 DM pregnancies (A-1 =85, A-2 =29, B=49, C =26, D =2, R =3, F=2). Most pregestational DM women were Type II (79.7%). Although the rate of APO was different between gestational and pregestation DM women (8.6% vs. 30.4%; p=0.001), there were no differences amongst women with pregestational diabetes (32.7% class B vs. 26.9% class C vs. 57.1% class D-F; p= 0.46). In pregestational Type II DM women, the presence of vascular disease was strongly associated with APO (15.1% vs. 50%; p =0.006). The rate of severe preeclampsia (p=0.012), macrosomia (p=0.026), and neonatal respiratory disease (p= 0.025)were also increased if vascular disease was present. In our population, the presence of vascular disease, rather than WCS was a better predictor of APO in pregestational DM women.