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Preterm Labor and Hypertensive Disorders in Adolescent Pregnancies With Diabetes Between 2006 and 2019
Estelle Everett1,2,3, Christina S Han4, Michael Richley5
1Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Insights
Adolescent pregnancies with diabetes, including type 1, type 2, and gestational diabetes, show significantly higher risks for preterm labor and hypertensive disorders. These findings highlight the need for targeted interventions to improve maternal and infant health outcomes in this population.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- Adolescent pregnancies represent a vulnerable population with unique health considerations.
- The prevalence of diabetes among adolescents is increasing, raising concerns about pregnancy complications.
- Hypertensive disorders and preterm labor are significant risks in pregnancy, particularly in adolescent mothers.
Purpose of the Study:
- To evaluate the association between diabetes (type 1, type 2, and gestational) and the risk of preterm labor in adolescent pregnancies.
- To assess the risk of hypertensive disorders in adolescent pregnancies complicated by diabetes.
- To identify trends and disparities in these pregnancy complications among adolescents.
Main Methods:
- Utilized the national Kids' Inpatient Database (KID) from 2006-2019, analyzing over 1.8 million adolescent labor and delivery admissions.
- Employed International Classification of Diseases (ICD) codes to identify cases of diabetes and pregnancy complications.
- Applied weighted logistic regression to determine the adjusted odds ratios for hypertensive disorders and preterm labor in relation to diabetes status.
Main Results:
- Adolescents with any form of diabetes (T1D, T2D, GDM) had a significantly higher prevalence of both hypertensive disorders and preterm labor compared to those without diabetes (p <0.001).
- Adjusted models revealed increased odds of hypertensive disorders (OR 4.32 for T1D, 4.18 for T2D, 1.99 for GDM) and preterm labor (OR 4.53 for T1D, 3.35 for T2D, 1.18 for GDM) in diabetic adolescents.
- Disparities in outcomes were observed based on race/ethnicity, insurance status, and income levels.
Conclusions:
- Increasing diabetes in adolescents poses a significant risk for adverse pregnancy outcomes, including preterm labor and hypertensive disorders.
- Despite a decrease in adolescent pregnancies, rates of hypertensive disorders have risen, emphasizing the impact of diabetes.
- Urgent implementation of targeted interventions is crucial to mitigate risks and ensure healthier outcomes for pregnant adolescents with diabetes.
Objective:
We sought to evaluate the risk of preterm labor and hypertensive disorders in adolescent pregnancies with and without diabetes.
Methods:
We evaluated 1,843,139 adolescents (≤20 years old) with labor and delivery admissions in the national Kids' Inpatient Database (KID) in years 2006, 2009, 2012, 2016, and 2019. International classification of disease codes was used to identify diabetes and medical factors affecting pregnancy. Weighted logistic regression was used to evaluate the association between diabetes and complications.
Results:
Among admissions, 0.2% had type 1 diabetes (T1D), 0.2% had type 2 diabetes (T2D), and 0.7% had gestational diabetes (GDM); 10.1% of admissions were complicated by hypertensive disorders and 5.8% by preterm labor. Compared to adolescents without diabetes, those with diabetes had a higher prevalence of hypertensive disorders (T1D: 35.4%, T2D: 37.8%, GDM: 24.9%, None: 9.9%; p <0:001) and preterm labor (T1D: 21.5%, T2D: 16.8%, GDM: 6.8%, none: 5.7%; p <0:001). In adjusted models, odds of hypertensive disorders were higher in later study years (2019 vs. 2006 OR 1.85, 95% CI 1.77-1.94), among those with T1D (OR 4.32, 95% CI 3.94-4.74), with T2D (OR 4.18, 95% CI 3.79-4.61), and with GDM (OR 1.99, 95% CI 1.89-2.10). Adjusted odds of preterm labor were higher among those with T1D (OR 4.53, 95% CI 4.09-5.02), with T2D (OR 3.35, 95% CI 2.96-3.78), and with GDM (OR 1.18, 95% CI 1.08-1.28); disparities were seen by race/ethnicity, insurance, and income.
Conclusions:
Diabetes, which is increasing among adolescents, is a significant risk factor for preterm labor and hypertensive disorders. Though the absolute number of adolescent pregnancies is decreasing, rates of hypertensive disorders have increased. Appropriate interventions are needed to ensure healthy outcomes for adolescents who are pregnant.
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