Study Identifies Link Between Prediabetes in Adolescence and Early Adulthood and Adverse Pregnancy Outcomes

Mount Sinai researchers have published a study that shows a link between prediabetes in young people and poor pregnancy outcomes later in life. The findings, published in Opening of the JAMA network September 24, could change how doctors routinely test or advise young people about their blood sugar levels and, in turn, minimize potential maternal and neonatal risks.

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. Prediabetes can increase the risk of heart disease and stroke, and disproportionately affects Hispanic, black, and low-income people.

The rate of prediabetes among young people in the United States has doubled over the past decade to nearly one in three between the ages of 12 and 19, according to JAMA Pediatrics.

In their study, the Mount Sinai researchers examined the prevalence of prediabetes before conception among adolescents and young adults, a group that is at highest risk for unplanned pregnancy and least likely to benefit from preconception health counseling.

The retrospective cohort study of more than 14,000 people aged 10 to 24 years was generated by linking data from the New York City birth registry, hospital discharges, and A1C registry between 2009 and 2017. The study included people who had no history of diabetes and at least one hemoglobin A1c (HbA1c) test before their first birth.

Researchers found that prediabetes before conception was associated with a two-fold increased likelihood of gestational diabetes at first delivery. Experts found that prediabetes during childhood and adolescence could lead to an 18 percent increased risk of hypertensive disorders during pregnancy, such as gestational hypertension and preeclampsia, or preterm delivery.

The study also assessed which level of hemoglobin A1c, a measure of a person’s average blood sugar level over the previous three months, was most predictive of gestational diabetes at first birth in adolescents and young adults. The optimal threshold was slightly lower for youth than for adults (5.6% versus 5.7%).

Overall, the study results support the need for clear clinical guidelines on how to screen and counsel young people who currently have high blood sugar levels without other risk factors, the researchers said.

“The lack of consistent guidelines for treating prediabetes before conception in adolescents may represent a missed opportunity to prevent pregnancy-related complications,” said corresponding author Katharine McCarthy, PhD, MPH, assistant professor of population health science and policy and of obstetrics, gynecology and reproductive sciences at the Icahn School of Medicine at Mount Sinai.

“Our results support expanded preconception hemoglobin A1c screening as a mechanism to address excess cardiometabolic risk earlier in life.”

Experts will then explore potential school policies and interventions that could reduce the risks of heart and metabolic diseases in adolescence and could benefit pregnancy and health throughout life.

Researchers from Columbia University Mailman School of Public Health, the New York Department of Health and Mental Hygiene, and the Department of Maternal-Fetal Medicine at Stamford Hospital contributed to the study.