The pregnant teenager with diabetes: Obstetrical and social risks

Abstract

Study Objectives: To provide information on the prevalence of diabetes in pregnancy in women less than 20 years of age; and to compare deliveries with and without the complication of diabetes in teens and older women with regard to cesarean delivery rate, delivery complications, and selected socioeconomic characteristics.

Design, Setting, Participants: Hospital claims for the 389,663 admissions for deliveries, ectopic pregnancies, and abortions from the 69 hospitals with obstetrical services in New Jersey in the years 1984, 1986, 1988.

Main Outcome Measures, Results: Women under 20 accounted for 31,153 (9.9%) of the 314,680 hospitalizations for obstetrical deliveries (DRGs 370–375). An ICD-9-CM code for diabetes mellitus was listed in 180 (0.58%) of teen deliveries. Of 68,836 hospitalizations for abortion (DRGs 380–381), adolescents accounted for 10,140, and of these, 21 (0.2%) had a code for diabetes. Intrauterine fetal death was coded in 1.7% of diabetic and 0.9% of nondiabetic teen deliveries. The cesarean rate was 18% for nondiabetic teens, 37% for diabetic teens, and 46% for diabetic women aged 20–45. The complicated-to-uncomplicated ratios for both cesarean and vaginal deliveries for teens with diabetes were more than six times the ratios for nondiabetic teens and double those for diabetic older women. Among women who had deliveries, diabetic and nondiabetic adolescent groups were similar in percentage of blacks and Hispanics, residence in high perinatal risk geographic area defined by WIC criteria, Medicaid coverage, and self-payment for hospitalization.

Conclusions: State-wide data on adolescent pregnancy complicated by diabetes reveal an increased risk of adverse outcomes. The social and medical issues of teenage pregnancy combined with the problems of a chronic disease call for further prospective studies of management alternatives.