Young adult prediabetes linked to future gestational diabetes

Young adult prediabetes linked to future gestational diabetes | Image Credit: © Proxima Studio - © Proxima Studio - stock.adobe.com.

Prediabetes in young people may lead to adverse pregnancy outcomes later in life, according to a recent study from Mount Sinai.¹

Prediabetes presents as increased blood sugar levels, but not high enough to be diagnosed as type 2 diabetes. Patients with prediabetes experience increased risks of heart disease and stroke, with Black, Hispanic, and low-income patients disproportionately affected.¹

Approximately 1 in 5 adolescents and 1 in 4 young adults in the United States are impacted by pediatric prediabetes.² Alongside heart disease, these individuals are more likely to experience type 2 diabetes later in life. However, data about the association between adolescent prediabetes and later cardiometabolic risk remains lacking.

Pregnancy is a significant predictor of underlying cardiometabolic dysfunction, with gestational diabetes first emerging during pregnancy. However, data about the odds of gestational diabetes during the first pregnancy in patients with adolescent and young adult preconception diabetes remains lacking.²

The Mount Sinai researchers conducted a study to evaluate impacts of prediabetes before conception among adolescents and young adults.¹ These individuals are at increased risk of unplanned pregnancy and receive the smallest benefits from preconception health counseling.

Data was obtained from a retrospective population-based cohort study in New York City and included first live births from 2009 to 2017.² Birth registration records, hospital diagnoses, and the hemoglobin A1c (HbA1c) Registry were assessed for relevant information.

Participants were aged 10 to 24 years, had at least 1 HbA1c test prior to conception, and did not have a previous live birth or record of diabetes or elevated HbA1c before pregnancy. No diabetes was determined as HbA1c under 5.7%, while prediabetes was HbA1c of 5.7% to under 6.5%.²

Gestational diabetes at first birth was reported as the primary outcome. Other indicators of cardiometabolic dysfunctions assessed included hypertensive disorders of pregnancy, preeclampsia or eclampsia, cesarean delivery, gestational age under 37 weeks, and macrosomia. Covariates included race and ethnicity, age, insurance type, educational attainment, nativity, smoking status, and prenatal alcohol use.²

There were 14,302 adolescents and young adults included in the analysis, 6.2% of whom were aged 10 to 19 years and 94.8% were aged 20 to 24 years. Of participants, 41% were Hispanic, 29% were Black, 18.1% were White, 10.6% were Asian, and 1.3% were other race or ethnicity.²

Medicaid or no insurance was reported in 80.5% of patients and only 1 preconception HbA1c test in 74.2%. Prediabetes at the last preconception test was reported in 20.2%. A cumulative gestational diabetes incidence of 6.6% was observed, with patients reporting gestational diabetes having higher mean HbA1c values during the prior preconception test.²

Prediabetes was most common in South and Southeast Asian individuals, followed by Black individuals, with White individuals having the lowest rate. Obesity and alcohol use during pregnancy were also more common in patients with prediabetes before pregnancy.²

The odds of having gestational diabetes at first birth were increased more than 2-fold among patients with preconception prediabetes, with an adjusted relative risk (aRR) of 2.21 compared to those with normoglycemia. Hypertensive disorder of pregnancy and preterm birth risks were also increased, both having an aRR of 1.18.²

Gestational diabetes was not associated with other adverse pregnancy outcomes except for a significant increase in hypertensive disorder of pregnancy risk when restricting the analysis to patients aged 10 to 19 years. The results for gestational diabetes were slightly greater among those aged 20 to 24 years.²

These results indicated an association between prediabetes in adolescents and young adults with gestational diabetes during first pregnancy. Investigators concluded prediabetes can be targeted as a modifiable risk factor to reduce the risks of adverse maternal and neonatal outcomes.²

“The lack of uniform preconception prediabetes treatment guidelines for adolescents may represent a missed opportunity to avert pregnancy-related complications,” said Katharine McCarthy, PhD, MPH, corresponding author and assistant professor at the Icahn School of Medicine at Mount Sinai.¹

“Our results support expanded preconception hemoglobin A1c screening as a mechanism to intervene on excess cardiometabolic risk earlier in the life course.”McCarthy added.

References

1. Mount Sinai study identifies link between prediabetes during adolescence and young adulthood with the likelihood of adverse pregnancy outcomes. Mount Sinai. September 24, 2024. Accessed September 27, 2024. https://www.mountsinai.org/about/newsroom/2024/mount-sinai-study-identifies-link-between-prediabetes-during-adolescence-and-young-adulthood-with-the-likelihood-of-adverse-pregnancy-outcomes
2. McCarthy KJ, Liu SH, Kennedy J, et al. Preconception HbA1c levels in adolescents and young adults and adverse birth outcomes. JAMA Netw Open. 2024;7(9):e2435136. doi:10.1001/jamanetworkopen.2024.35136