Pregnancy Outcomes in Youth With Type 2 Diabetes: The TODAY Study Experience.
Georgeanna J Klingensmith, Laura Pyle, Kristen J Nadeau, Linda A Barbour, Robin S Goland, Steven M Willi, Barbara Linder, Neil H White, TODAY Study Group
Author Information
Georgeanna J Klingensmith: Barbara Davis Center for Diabetes and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Laura Pyle: The Biostatistics Center, George Washington University, Rockville, MD laura.pyle@ucdenver.edu.
Kristen J Nadeau: Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Linda A Barbour: 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.
Robin S Goland: Naomi Berrie Diabetes Center, Columbia University, New York, NY.
Steven M Willi: Department of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA.
Barbara Linder: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Neil H White: Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO.
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.
