Outcomes, care utilization, and expenditures in adolescent pregnancy complicated by diabetes

Abstract

Background and Objective Adolescence and pregestational diabetes separately increase risks of adverse pregnancy outcomes, but little is known about their combined effect. To analyze pregnancy outcomes, healthcare utilization, and expenditures in adolescent pregnancies with and without pregestational diabetes using a national claims database. Methods Retrospective study using Truven Health MarketScan Commercial Claims and Encounters Database, 2011 to 2015. Females 12 to 19 years old, continuously enrolled for at least 12 months before a livebirth until 2 months after, were included. Pregestational diabetes, diabetes complications (ketoacidosis, retinopathy, neuropathy, nephropathy), comorbidities, and pregnancy outcomes (preeclampsia, preterm delivery, high birthweight, cesarean delivery) were identified using claims data algorithms. Healthcare utilization and payer expenditure were tabulated per enrollee. Multivariate logistic regressions assessed pregnancy outcomes; multivariate OLS regression assessed payer expenditures. Results About 33 502 adolescents were included. Adolescents without diabetes had pregnancy outcomes consistent with national estimates. Adolescents with uncomplicated diabetes had increased odds of preeclampsia adjusted odds ratios 2.41 (95% confidence interval 1.93‐3.02), preterm delivery 1.50 (1.21‐1.87), high birthweight 1.84 (1.50‐2.27), and cesarean delivery 1.81 (1.52‐2.15). Diabetes with ketoacidosis and/or end‐organ damage had higher odds of preeclampsia 5.62 (2.77‐11.41), preterm delivery 5.81 (3.00‐11.25), high birthweight 2.38 (1.08‐5.24), and cesarean delivery 3.43 (1.78‐6.64). Adolescents with diabetes utilized significantly more outpatient and inpatient care during pregnancy. Payer expenditures increased by 45.3% (34.8‐55.9%) among adolescents with diabetes and by 82.6% (49.1‐116.0%) among adolescents with diabetes complicated by ketoacidosis and/or end‐organ damage. Conclusion Compared with normal adolescent pregnancies, pregestational diabetes significantly increases risks of adverse pregnancy outcomes and significantly escalates healthcare utilization and cost.

Pregnancy in teenagers diagnosed with type 1 diabetes mellitus in childhood: a national population-based e-cohort study

“…Comparisons between groups were made using χ 2 testing and the resulting p values are shown ND, not determined (number suppressed as fewer than 5 per cell or would allow a value of less than 5 to be calculated) increased pregnancy complication rates compared with teenagers without diabetes [16]. Consistent with our findings, the researchers reported an increased risk of pre-eclampsia, preterm delivery and high birthweight [16]. However, they did not differentiate between types of pregestational diabetes and no socioeconomic data were included.…”

“…The published literature on pregnancy outcomes in teenagers with type 1 diabetes is limited. A recently published study of pregnancy outcomes in teenagers with pregestational diabetes reported that adverse outcomes are more common in teenagers with pregestational diabetes than in teenagers without diabetes, but did not compare outcomes between teenagers with diabetes and older women with diabetes [16]. The largest published study to date comparing outcomes in teenagers and older women with type 1 diabetes included just 18 teenage pregnancies, and suggested that the children of teenagers with type 1 diabetes are at higher risk of congenital malformations [17].…”

Long‐acting contraception in adolescents and young women with type 1 and type 2 diabetes

“…A recent study has also shown more frequent hospital admissions of the offspring of adolescents with type 1 diabetes (T1D) in the first year after delivery 15 . Pregnancy in adolescents with diabetes has a worse outcome than pregnancy in adult women with T1D and in adolescents without diabetes, which highlights the importance of pregnancy prevention in young women with diabetes 16,17 …”

“…15 Pregnancy in adolescents with diabetes has a worse outcome than pregnancy in adult women with T1D and in adolescents without diabetes, which highlights the importance of pregnancy prevention in young women with diabetes. 16,17 Maternal hyperglycemia during pregnancy is harmful to both the mother and the fetus and has a central role in the explanation of complications of pregnancy in women with diabetes. Therefore, the recommendation is to achieve an HbA1c level of ≤6.5% in the months T A B L E 1 Pregnancy rates of the different contraceptive alternatives for adolescents Note: Efficacy is shown as the Pearl Index, which is defined as the number of pregnancies in 100 women during one year of exposure or the proportion of women who experienced an unintended pregnancy within the first year of use.…”

Deliveries Among Patients Aged 11–19 Years and Risk for Adverse Pregnancy Outcomes

“…14,15 Although adolescent deliveries have decreased over recent decades, 16 there are few data on recent comorbidity and adverse outcomes trends specifically among adolescents. 17,18 Older research supported that adolescent deliveries were associated with increased risk for a range of adverse outcomes. [19][20][21] Further characterization of underlying comorbidity and risk among adolescent deliveries may be of public health importance.…”