title: Pregnancy Outcomes in Youth With Type 2 Diabetes: The TODAY Study Experience.
abstract: OBJECTIVE
  We evaluated pregnancy outcomes, maternal and fetal/neonatal, during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.
  
  
  METHODS
  The TODAY study was a randomized controlled trial comparing three treatment options for youth with type 2 diabetes. Informed consent included the requirement for contraception, including abstinence; this was reinforced at each visit. Following informed consent, self-reported data related to the mother's prenatal care and delivery and the infant's health were retrospectively collected. When permitted, maternal medical records and infant birth records were reviewed.
  
  
  RESULTS
  Of the 452 enrolled female participants, 46 (10.2%) had 63 pregnancies. Despite continued emphasis on adequate contraception, only 4.8% of the pregnant participants reported using contraception prior to pregnancy. The mean age at first pregnancy was 18.4 years; the mean diabetes duration was 3.17 years. Seven pregnancies were electively terminated; three pregnancies had no data reported. Of the remaining 53 pregnancies, 5 (9.4%) resulted in early pregnancy loss, and 7 (13%) resulted in loss with inadequate pregnancy duration data. Two pregnancies ended in stillbirth, at 27 and 37 weeks, and 39 ended with a live-born infant. Of the live-born infants, six (15.4%) were preterm and eight (20.5%) had a major congenital anomaly.
  
  
  CONCLUSIONS
  Despite diabetes-specific information recommending birth control and the avoidance of pregnancy, 10% of the study participants became pregnant. Pregnancies in youth with type 2 diabetes may be especially prone to result in congenital anomalies. Reasons for the high rate of congenital anomalies are uncertain, but may include poor metabolic control and extreme obesity.
authors.affiliation: Barbara Davis Center for Diabetes and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
authors.affiliation: The Biostatistics Center, George Washington University, Rockville, MD laura.pyle@ucdenver.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Nadeau
authors.affiliation: Department of Medicine, Division of Endocrinology, and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Barbour
authors.affiliation: Naomi Berrie Diabetes Center, Columbia University, New York, NY.
authors.forename: Robin S
authors.initials: RS
authors.lastname: Goland
authors.affiliation: Department of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Willi
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Barbara
authors.initials: B
authors.lastname: Linder
authors.affiliation: Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
mesh_terms: D000293:Adolescent; D036861:Delivery, Obstetric; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010349:Patient Compliance; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D011295:Prenatal Care; D050497:Stillbirth