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Diabetes Care. 2016 Jan;39(1):122-9. doi: 10.2337/dc15-1206. Epub 2015 Dec 1.

Pregnancy Outcomes in Youth With Type 2 Diabetes: The TODAY Study Experience.

Collaborators (199)

McKay S, Haymond M, Anderson B, Bush C, Gunn S, Holden H, Jones SM, Jeha G, McGirk S, Thamotharan S, Cuttler L, Abrams E, Casey T, Dahms W, Ievers-Landis C, Kaminski B, Koontz M, MacLeish S, McGuigan P, Narasimhan S, Geffner M, Barraza V, Chang N, Conrad B, Dreimane D, Estrada S, Fisher L, Fleury-Milfort E, Hernandez S, Hollen B, Kaufman F, Law E, Mansilla V, Miller D, Muñoz C, Ortiz R, Ward A, Wexler K, Xu YK, Yasuda P, Levitt Katz L, Berkowitz R, Boyd S, Johnson B, Kaplan J, Keating C, Lassiter C, Lipman T, McGinley G, McKnight H, Schwartzman B, Willi S, Arslanian S, Bacha F, Foster S, Galvin B, Hannon T, Kriska A, Libman I, Marcus M, Porter K, Songer T, Venditti E, Goland R, Gallagher D, Kringas P, Leibel N, Ng D, Ovalles M, Seidman D, Laffel L, Goebel-Fabbri A, Hall M, Higgins L, Keady J, Malloy M, Milaszewski K, Rasbach L, Nathan DM, Angelescu A, Bissett L, Ciccarelli C, Delahanty L, Goldman V, Hardy O, Larkin M, Levitsky L, McEachern R, Norman D, Nwosu D, Park-Bennett S, Richards D, Sherry N, Steiner B, Tollefsen S, Carnes S, Dempsher D, Flomo D, Whelan T, Wolff B, Weinstock R, Bowerman D, Bristol S, Bulger J, Hartsig J, Izquierdo R, Kearns J, Saletsky R, Trief P, Zeitler P, Abramson N, Bradhurst A, Celona-Jacobs N, Higgins J, Kelsey MM, Klingensmith G, Nadeau K, Witten T, Copeland K, Boss E, Brown R, Chadwick J, Chalmers L, Chernausek S, Hebensperger A, Macha C, Newgent R, Nordyke A, Olson D, Poulsen T, Pratt L, Preske J, Schanuel J, Sternlof S, Lynch J, Amodei N, Barajas R, Cody C, Hale D, Hernandez J, Ibarra C, Morales E, Rivera S, Rupert G, Wauters A, White N, Arbeláez A, Flomo D, Jones J, Jones T, Sadler M, Tanner M, Timpson A, Welch R, Caprio S, Grey M, Guandalini C, Lavietes S, Rose P, Syme A, Tamborlane W, Hirst K, Edelstein S, Feit P, Grover N, Long C, Pyle L, Linder B, Marcovina SM, Harting J, Shepherd J, Fan B, Marquez L, Sherman M, Wang J, Nichols M, Mayer-Davis E, Liu Y, Lima J, Gidding S, Puccella J, Ricketts E, Danis R, Domalpally A, Goulding A, Neill S, Vargo P, Wilfley D, Aldrich-Rasche D, Franklin K, Massmann C, O'Brien D, Patterson J, Tibbs T, Van Buren D, Palmert M, Ratner R, Dremaine D, Silverstein J.

Author information

1
Barbara Davis Center for Diabetes and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
2
The Biostatistics Center, George Washington University, Rockville, MD laura.pyle@ucdenver.edu.
3
Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
4
Department of Medicine, Division of Endocrinology, and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado School of Medicine, Aurora, CO.
5
Naomi Berrie Diabetes Center, Columbia University, New York, NY.
6
Department of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA.
7
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
8
Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO.

Abstract

OBJECTIVE:

We evaluated pregnancy outcomes, maternal and fetal/neonatal, during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.

RESEARCH DESIGN AND METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00081328.

PMID:
26628417
PMCID:
PMC4686849
DOI:
10.2337/dc15-1206
[Indexed for MEDLINE]
Free PMC Article

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