749: Impact of distance traveled to prenatal care on outcomes of pregnancies complicated by pregestational diabetes

The concentration of high-risk pregnancy care in urban centers and rural hospital closures have caused concern about the distances patients travel for care and its impact on outcomes. We aimed to assess the impact of distance traveled to site of prenatal care (PNC) on perinatal outcomes in women with pregestational diabetes (DM). Retrospective cohort of all women with DM delivering at a single academic center from 2007-2013. Women were excluded for major medical problems (not hypertension), fetal anomalies, and entry to PNC ≥26 weeks. Exposure was classified into residing <30 miles, 30-60 miles, and >60 miles from the site of PNC. The primary maternal outcome was cesarean delivery (CD). Secondary maternal outcomes were primary CD, markers of glycemic control, and preeclampsia. The primary neonatal outcome was macrosomia (>4000g) and secondary neonatal outcomes were shoulder dystocia, neonatal hypoglycemia (<40 mg/dL), and hyperbilirubinemia. Chi square, Fisher exact, and ANOVA were used as appropriate. A multivariable logistic regression model was performed controlling for important confounding variables using <30 miles as the referent group. Impact of distance from the hospital was also evaluated as a continuous variable. Of 475 women, 341 (71.8%) lived <30 miles, 72 (15.2%) 30-60 miles, and 62 (13.1%) >60 miles from the site of PNC. Women living closest to the site of PNC were more likely to be black and less likely to use diabetic medications prior to or use insulin during pregnancy. Odds of CD and primary CD increased with distance from the hospital (Table). For each 1 mile over 30 miles lived from the site of PNC, the odds of primary CD increased by 1% (95% CI 1.003-1.030). Glycemic control, macrosomia, shoulder dystocia and hyperbilirubinemia did not differ between groups. Odds of neonatal hypoglycemia doubled with increased distance from PNC (Table). Per mile over 30 miles, the odds increased 1% (95% CI 1.004-1.021). Traveling further for prenatal care was associated with increased odds of cesarean and neonatal hypoglycemia, in spite of no detectable differences in glycemic control. When access to care and maternal morbidity are explored, distance from site of care should be considered as a contributing factor to patient and public health outcomes.