Youth Prediabetes Linked to Likelihood of Poor Pregnancy Outcomes

New research conducted at Columbia Mailman School of Public Health and Mount Sinai School of Medicine shows a link between prediabetes among young people and adverse pregnancy outcomes later in life. The findings could alter how doctors routinely screen or counsel youth on blood glucose levels, and subsequently, minimize potential maternal and neonatal risks. The results are published in JAMA Network Open.

“This study is an important step in tying lifecourse cardiometabolic health to optimal pregnancy outcomes,” said Teresa Janevic, PhD, associate professor of Epidemiology at Columbia Mailman School of Public Health and senior author. “The findings point to an opportunity to invest in adolescent health to promote later healthy pregnancies.”

Prediabetes is a serious health condition that occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes, or persistently high blood sugar levels. Prediabetes can increase risks for heart disease and stroke, and disproportionally burdens Hispanic, Black, and low-income individuals. The prediabetes rate among youth in the United States has doubled in the last decade to nearly one in three aged 12 to 19 years, according to JAMA Pediatrics.

In their new study, the researchers examined the significance of prediabetes prior to conception among adolescents and young adults, a group that is most at risk of unplanned pregnancy and least likely to benefit from preconception health counseling.

The analysis of more than 14,000 people between ages 10 and 24 years uses data from the APPLE Study, a research database generated by linking New York City birth registry, hospital discharge, and A1C data between 2009 and 2017 and included individuals who had no history of diabetes and at least one hemoglobin A1c (HbA1c) test prior to first birth. The researchers found that preconception prediabetes was associated with more than twice the likelihood of gestational diabetes at future first birth. The experts discovered that prediabetes during youth and adolescence could result in an 18 percent increased risk of hypertensive disorders during pregnancy, such as gestational hypertension and preeclampsia, or preterm delivery.

The study also assessed what level of hemoglobin A1c, a measure of a person’s average blood sugar level over the prior three months, was most predictive of gestational diabetes at first birth among adolescents and young adults. The optimal threshold was slightly lower for young people than that used for adults (5.6 percent vs. 5.7 percent). Overall, the study results support the need to establish clear clinical guidance on how to screen and counsel young people who currently have elevated blood glucose levels without other risk factors, the researchers said.

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

The results support expanded preconception hemoglobin A1c screening as a mechanism to intervene on excess cardiometabolic risk earlier in the life course,  noted the researchers.

The experts will next investigate potential school policies and interventions that could reduce risks for heart and metabolism-related conditions in adolescence, and may benefit pregnancy and health outcomes across the lifespan.

Co-authors are Shelley Liu and Victoria Mayer, Mount Sinai; Joseph Kennedy, Tai Chan, Kacie Seil, Bahman Tabael, and Gretchen Van Wye, NYCDOHMH; Frances Howell and Natalie Boychuk, Columbia Mailman School of Public Health; and Luciana Vieira, Stamford Hospital.

The research was supported by the National Institutes of Health, grants R01DK134725, R21DK122266, and UL1TR004419.