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Research Project: Pediatric Clinical Nutrition

Location: Children's Nutrition Research Center

Title: Pregnancy outcomes in youth with type 2 diabetes: The TODAY Study experience

Author
item Klingensmith, Georgeanna - University Of Colorado
item Pyle, Laura - George Washington University
item Nadeau, Kristen - University Of Colorado
item Barbour, Linda - University Of Colorado
item Goland, Robin - Columbia University - New York
item Willi, Steven - Children'S Hospital - Philadelphia, Pennsylvania
item Linder, Barbara - National Institute Of Diabetes And Digestive And Kidney Diseases
item White, Neil - Washington University School Of Medicine
item Bacha, Fida - Children'S Nutrition Research Center (CNRC)

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/21/2015
Publication Date: 1/1/2016
Citation: Klingensmith, G.J., Pyle, L., Nadeau, K.J., Barbour, L.A., Goland, R.S., Willi, S.M., Linder, B., White, N.H., TODAY Study Group. 2016. Pregnancy outcomes in youth with type 2 diabetes: The TODAY Study experience. Diabetes Care. 39(1):122-129.

Interpretive Summary: Type 2 diabetes (T2D) was originally considered a disease of adulthood. However, in the last several decades, the prevalence of T2D has increased in youth. We evaluated pregnancy outcomes, maternal and fetal/neonatal, during the Treatment Options for T2D in Adolescents and Youth (TODAY) study, the largest multicenter center of T2D in youth. There were 63 pregnancies in TODAY. Seven were electively terminated; three pregnancies had no data reported. Of the remaining 53 pregnancies, 5 (9.4%) resulted in early pregnancy loss, and 7 (13%) resulted in loss with inadequate pregnancy duration data. Two pregnancies ended in stillbirth, at 27 and 37 weeks, and 39 ended with a live-born infant. Of the live-born infants, six (15.4%) were preterm and eight (20.5%) had a major congenital anomaly. We concluded that despite diabetes-specific information recommending birth control and the avoidance of pregnancy, 10% of the study participants became pregnant. Pregnancies in youth with type 2 diabetes may be especially prone to result in congenital anomalies.

Technical Abstract: We evaluated pregnancy outcomes, maternal and fetal/neonatal, during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. The TODAY study was a randomized controlled trial comparing three treatment options for youth with type 2 diabetes. Informed consent included the requirement for contraception, including abstinence; this was reinforced at each visit. Following informed consent, self-reported data related to the mother’s prenatal care and delivery and the infant’s health were retrospectively collected. When permitted, maternal medical records and infant birth records were reviewed. Of the 452 enrolled female participants, 46 (10.2%) had 63 pregnancies. Despite continued emphasis on adequate contraception, only 4.8% of the pregnant participants reported using contraception prior to pregnancy. The mean age at first pregnancy was 18.4 years; the mean diabetes duration was 3.17 years. Seven pregnancies were electively terminated; three pregnancies had no data reported. Of the remaining 53 pregnancies, 5 (9.4%) resulted in early pregnancy loss, and 7 (13%) resulted in loss with inadequate pregnancy duration data. Two pregnancies ended in stillbirth, at 27 and 37 weeks, and 39 ended with a live-born infant. Of the live-born infants, six (15.4%) were preterm and eight (20.5%) had a major congenital anomaly. Despite diabetes-specific information recommending birth control and the avoidance of pregnancy, 10% of the study participants became pregnant. Pregnancies in youth with type 2 diabetes may be especially prone to result in congenital anomalies. Reasons for the high rate of congenital anomalies are uncertain, but may include poor metabolic control and extreme obesity.