Teenage pregnancy in type 1 diabetes mellitus

Abstract

Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995-2007. TG booked to the combined diabetes-obstetrical service at a median gestational age of 11 weeks (range 6-22) compared to 7 weeks in CON (range 4-40, p < 0.02). Glycaemic was worse in TG compared to CON at 13, 26 and 35 weeks gestation, despite higher insulin doses. First trimester miscarriage rate did not differ between groups. Major congenital anomaly rate was 6.2% (1/16) compared to 3.2% in CON. This preliminary study has demonstrated that pregnant teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high-risk group for adverse pregnancy outcomes.

Ovulation rate in adolescents with type 1 diabetes mellitus

“…They found that these patients believed that they were only moderately susceptible to becoming pregnant, so most did not exhibit protective family planning behaviors. Unfortunately, once the T1D patient becomes pregnant, she is at a higher risk of complications from pregnancy, as is her newborn (24,25).…”

Type 1 Diabetes in Children and Adolescents

“…Adolescents with diabetes should receive regular counselling about sexual health and contraception. Unplanned pregnancies should be avoided, as pregnancy in adolescent females with type 1 diabetes with suboptimal metabolic control may result in higher risks of maternal and fetal complications than in older women with type 1 diabetes who are already at increased risk compared to the general population (102). Oral contraceptives, intrauterine devices and barrier methods can be used safely in the vast majority of adolescents (103).…”

Obstetric and Perinatal Outcomes in Women with Type 1 Diabetes Mellitus

“…There is a correlation between raised maternal blood glucose levels and adverse perinatal outcomes. Key elements for improving outcomes included a good glycaemic control with intensive insulin therapy or insulin pumps starting before conception and maintained during the time of organogenesis and, ideally, throughout the pregnancy, home blood glucose monitoring, continuous blood glucose monitors and fetal ultrasonography [5,6]. Perinatal mortality and morbidity is also lower in T1DM women who attend prepregnancy counseling and who are planning their pregnancy [7].…”