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Birth defects more common in pregnancies of young females with type 2 diabetes, study suggests

A large clinical trial finds that the children of young females with type 2 diabetes are more likely to have birth defects.
The findings were part of the TODAY (Treatment Options for type 2 diabetes in Adolescents and Youth) study, a randomised controlled trial comparing three treatment options for young people with type 2 diabetes. The results were revealed on Tuesday 1 December at the World Diabetes Congress 2015.
699 overweight or obese youths with type 2 diabetes were recruited, all of whom were aged between 10 and 17. They either received metformin alone, metformin plus rosiglitazone, or metformin plus an intensive family-based lifestyle program. The program aimed to improve eating habits, encourage weight loss and increase physical activity.
Pregnancy prevention wasn’t a primary focus of the TODAY study, and information on pregnancy outcomes led to investigators collecting data retrospectively on maternal and infant records.
All 452 females in the study signed consent forms that specified “an acceptable method of birth control” be used, while the participants were educated throughout the study to defer pregnancy until an HbA1c of less than six per cent (42.1 mmol/mol) was achieved.
46 participants had 63 pregnancies over a four-year period. Among the 39 live births, six were premature, and eight had major congenital anomalies. Two pregnancies ended in stillbirths, while seven pregnancies were electively terminated. The mean age at first pregnancy was 18.4 years.
Only eight of the young women who became pregnant reported remembering the counselling on how important glycemic control was before pregnancy.
Lead author Dr. Georgeanna J Klingensmith, MD, professor of pediatrics at the University of Colorado explained that the rate of congenital anomalies was three to four times greater than in adult women with type 1 or type 2 diabetes.
Klingensmith told Medscape Medical News: “The message I would like to get out is the need to continuously remind teens and young adult women of the need to avoid pregnancy unless their diabetes is well controlled, the need to call their diabetes doctor as soon as they think they are pregnant, and to encourage long-acting contraception in those who may be at highest risk for an unexpected pregnancy.”
The researchers were unsure as to why there was such a high rate of birth defects, but suggested poor metabolic control and extreme obesity could have been contributing factors.
The study was published in the online journal Diabetes Care.

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