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Young Women with Type 2 Diabetes Show High Rate of Congenital Anomalies

Reasons may include poor metabolic control and extreme obesity.

Diabetes has a huge impact on patients’ lives, particularly in pregnant women. About 9 out of 100 women in the United States have diabetes. Pre-existing diabetes like type 1 or type 2 is different from gestational diabetes, which happens during pregnancy. Women with pre-existing diabetes experience many difficulties during pregnancy, such as birth defects, miscarriage, or stillbirth. Due to the prevalence of childhood obesity, more and more young women develop type 2 diabetes. In 2009, the SEARCH for Diabetes in Youth Study showed the percentage of diabetes in young women between 15-19 years of age in the United States ranged from 5.5% to 8%, depending on race and region of the country. Therefore, the care of pregnancy in youth with pre-existing diabetes is important.

There is limited data of outcome and rates of teenage pregnancy among girls with type 2 diabetes. A study published in Diabetes Care, and presented at the World Diabetes Congress 2015, showed the infants of young women with type 2 diabetes had high rates of congenital anomalies, even though those young women were educated to use contraception. Due to the high rate of congenital anomalies in young women with type 2 diabetes, researchers emphasized teenagers with type 2 diabetes should avoid pregnancy unless they can control their blood glucose levels, and should use contraception to prevent an unexpected pregnancy.

It was known as the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, and it was a randomized controlled trial comparing three treatment options for youth with type 2 diabetes. Three treatment options included metformin alone, metformin plus rosiglitazone, or metformin plus diabetic education program. There were 452 overweight or obese youth between 10-17 years old who were randomized and received one of the treatments and informed consent, which included the requirement for contraception. Since rosiglitazone was a pregnancy class C medication, researchers reinforced participants either used an acceptable method of birth control, like abstinence, or the treatment of this study would be terminated. During the study, participants were provided standard diabetic education at every study visit, such as modifying lifestyle, exercise, weight control, pregnancy planning, and contraception.

The results showed 46 (10.2%) had 63 pregnancies, and only 4.8% of the pregnant girls used contraception before pregnancy. Congenital anomalies were very high among the infants of young females with type 2 diabetes. Among the 53 remaining pregnancies, 5 experienced an early loss of pregnancy, and 7 experienced inadequate pregnancy duration. Among 39 live-born infants, 6 were preterm and 8 had congenital anomaly. The study reported three to four times greater than that reported in adult women with type 1 and type 2 diabetes, but it was unclear for the high congenital-anomaly rate.

Even though participants were counseled on the risk of pregnancy with diabetes and provided proper diabetes education, there was still a 10% pregnancy rate in this study. Researchers were concerned about the low rate of contraception and the large number of congenital abnormalities in youth with type 2 diabetes. These anomalies included cardiac anomalies, polycystic kidney disease, microcephaly, cleft palate, and jejunal atresia. There were several factors that may lead to congenital anomalies, which were discussed in the study, such as uncontrolled HbA1c, increased maternal BMI to 35-40kg/m2, and a history of smoking.

Among the 53 full-term pregnancies, there were no differences in HbA1c closest to conception between the 27 with a healthy infant and the 26 with miscarriage, stillbirth, prematurity, or congenital anomaly.

Pre-existing diabetes makes pregnancies harder for a young teenager. Contraception and planning pregnancy become extremely important. Study results showing an association between diabetes and congenital anomalies are concerning. Researchers call for more research about pregnancy outcomes and the long-term death of children and youth born to young women with type 2 diabetes.

Practice Pearls:

  • Among 39 live-born infants, 6 were preterm and 8 had congenital anomaly.
  • The results showed high congenital anomalies in infants of young women with type 2 diabetes.
  • A major concern has to be the large number of stillbirths and congenital abnormalities even with counseling of the teens on the dangers of getting pregnant when their blood sugars are not in control.
  1. Klingensmith GJ, Pyle L, Nadeau KJ, Barbour LA, Goland RS, Willi SM, Linder B, White NH. Pregnancy Outcomes in Youth With Type 2 Diabetes: The TODAY Study Experience. Diabetes Care. December 2015.
  2. Heerwagen MJ, Miller MR, Barbour LA, Friedman JE. Maternal obesity and fetal metabolic programming: a fertile epigenetic soil. Am J Physiol Regul Integr Comp Physiol 2010;299: R711–R722