In the Journals

Pregnant teens with diabetes at ‘exceptional risk’ for complications

Compared with healthy adolescents who become pregnant, those with diabetes before pregnancy are at higher risk for experiencing multiple complications, such as preeclampsia, preterm delivery and cesarean delivery; diabetic ketoacidosis more than doubles the odds for experiencing such outcomes, according to an analysis of claims data published in Pediatric Diabetes.

“Type 1 and type 2 diabetes are increasingly common in adolescence, and adolescent girls with diabetes have a collision of risk factors that elevate their likelihood of unintended pregnancy and poor pregnancy outcomes,” Jaden R. Kohn, MD, MPH, of the department of management, policy and community health at the University of Texas Health Sciences Center at Houston, and colleagues wrote in the study background. “Adolescents with chronic disease (including diabetes) engage in more risk-taking behavior than peers, including unprotected sexual intercourse. ... Overall, poor glycemic control and rising insulin resistance are associated with menstrual irregularities, as well as poor pregnancy outcomes should conception occur.”

In a retrospective study, Kohn and colleagues analyzed 2011-2015 data from 33,502 adolescents using the Truven Health MarketScan Commercial Claims and Encounters Database. Using claims data algorithms, researchers identified cases of diabetes diagnosed before pregnancy (n = 639), diabetes complications and comorbidities, and pregnancy outcomes. Health care utilization and payer expenditure were calculated per enrollee. Researchers used logistic regression analysis to assess pregnancy outcomes and payer expenditures.

Among adolescents with pregestational diabetes, 30 experienced at least one episode of diabetic ketoacidosis (DKA), eight had diabetic nephropathy, six had diabetic retinopathy and one had diabetic neuropathy.

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Compared with healthy adolescents who become pregnant, those with diabetes before pregnancy are at higher risk for experiencing multiple complications, such as preeclampsia, preterm delivery and cesarean delivery.
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Compared with adolescents without diabetes, those with diabetes were more likely to experience preeclampsia (adjusted OR = 2.41; 95% CI, 1.93-3.02), preterm delivery (aOR = 1.5; 95% CI, 1.21-1.87), high offspring birth weight (aOR = 1.84; 95% CI, 1.5-2.27) and cesarean delivery (aOR = 1.81; 95% CI, 1.52-2.15).

Diabetes complications further increased pregnancy-related risks, according to researchers. Teens with diabetes who experienced DKA or end-stage organ damage had markedly increased risks for experiencing preeclampsia (aOR = 5.62; 95% CI, 2.77-11.41), preterm delivery (aOR = 5.81; 95% CI, 3-11.25), high offspring birth weight (aOR = 2.38; 95% CI, 1.08-5.24) and cesarean delivery (aOR = 3.43; 95% CI, 1.78-6.64) compared with adolescents without diabetes complications, according to researchers.

Researchers also found that payer expenditures increased by 45.3% for adolescents with diabetes and by 82.6% for adolescents with diabetes who experienced DKA or end-organ damage.

“Our study reinforces the importance of comprehensive reproductive health education for adolescents with diabetes — including the serious risks of pregnancy and need for reliable contraception when these adolescents become sexually active,” the researchers wrote. “Adolescents with pregestational diabetes who become pregnant are at exceptional risk for adverse pregnancy outcomes ... and should be closely monitored. Pregnancy prevention strategies and close monitoring during pregnancy may help to mitigate adverse outcomes and the associated high costs of health care utilization in this population.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

Compared with healthy adolescents who become pregnant, those with diabetes before pregnancy are at higher risk for experiencing multiple complications, such as preeclampsia, preterm delivery and cesarean delivery; diabetic ketoacidosis more than doubles the odds for experiencing such outcomes, according to an analysis of claims data published in Pediatric Diabetes.

“Type 1 and type 2 diabetes are increasingly common in adolescence, and adolescent girls with diabetes have a collision of risk factors that elevate their likelihood of unintended pregnancy and poor pregnancy outcomes,” Jaden R. Kohn, MD, MPH, of the department of management, policy and community health at the University of Texas Health Sciences Center at Houston, and colleagues wrote in the study background. “Adolescents with chronic disease (including diabetes) engage in more risk-taking behavior than peers, including unprotected sexual intercourse. ... Overall, poor glycemic control and rising insulin resistance are associated with menstrual irregularities, as well as poor pregnancy outcomes should conception occur.”

In a retrospective study, Kohn and colleagues analyzed 2011-2015 data from 33,502 adolescents using the Truven Health MarketScan Commercial Claims and Encounters Database. Using claims data algorithms, researchers identified cases of diabetes diagnosed before pregnancy (n = 639), diabetes complications and comorbidities, and pregnancy outcomes. Health care utilization and payer expenditure were calculated per enrollee. Researchers used logistic regression analysis to assess pregnancy outcomes and payer expenditures.

Among adolescents with pregestational diabetes, 30 experienced at least one episode of diabetic ketoacidosis (DKA), eight had diabetic nephropathy, six had diabetic retinopathy and one had diabetic neuropathy.

#
Compared with healthy adolescents who become pregnant, those with diabetes before pregnancy are at higher risk for experiencing multiple complications, such as preeclampsia, preterm delivery and cesarean delivery.
Shutterstock

Compared with adolescents without diabetes, those with diabetes were more likely to experience preeclampsia (adjusted OR = 2.41; 95% CI, 1.93-3.02), preterm delivery (aOR = 1.5; 95% CI, 1.21-1.87), high offspring birth weight (aOR = 1.84; 95% CI, 1.5-2.27) and cesarean delivery (aOR = 1.81; 95% CI, 1.52-2.15).

Diabetes complications further increased pregnancy-related risks, according to researchers. Teens with diabetes who experienced DKA or end-stage organ damage had markedly increased risks for experiencing preeclampsia (aOR = 5.62; 95% CI, 2.77-11.41), preterm delivery (aOR = 5.81; 95% CI, 3-11.25), high offspring birth weight (aOR = 2.38; 95% CI, 1.08-5.24) and cesarean delivery (aOR = 3.43; 95% CI, 1.78-6.64) compared with adolescents without diabetes complications, according to researchers.

Researchers also found that payer expenditures increased by 45.3% for adolescents with diabetes and by 82.6% for adolescents with diabetes who experienced DKA or end-organ damage.

“Our study reinforces the importance of comprehensive reproductive health education for adolescents with diabetes — including the serious risks of pregnancy and need for reliable contraception when these adolescents become sexually active,” the researchers wrote. “Adolescents with pregestational diabetes who become pregnant are at exceptional risk for adverse pregnancy outcomes ... and should be closely monitored. Pregnancy prevention strategies and close monitoring during pregnancy may help to mitigate adverse outcomes and the associated high costs of health care utilization in this population.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.