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From the Journals

Teen Prediabetes: A Hidden Risk for Pregnancy Complications

New study finds preconception prediabetes in teens and young adults more than doubles gestational diabetes risk, suggesting a critical window for early intervention and screening.

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Preconception prediabetes more than doubled the risk of developing gestational diabetes at first live birth in over 14,000 adolescents and young adults, according to a recent study published in JAMA Network Open.

Investigators evaluated the association between preconception HbA1c levels and the risk of gestational diabetes and adverse birth outcomes in adolescents and young adults. The study, conducted from 2009 to 2017, included 14,302 individuals aged 10 to 24 years (mean age 22.10 years) in New York City. It assessed the impact of preconception prediabetes (HbA1c ≥ 5.7% to < 6.5%) on pregnancy outcomes using linked birth registry, hospital discharge, and New York City Department of Health A1C Registry data.

The study population was diverse, with 41% identifying as Hispanic, 29% as Black, 18.1% as White, 10.6% as Asian, and 1.3% as other or unknown race or ethnicity. Preconception prediabetes was present in 20.2% of participants, while 79.7% had HbA1c levels consistent with normoglycemia (HbA1c < 5.7%).

The findings demonstrated that preconception prediabetes was associated with more than twice the risk of gestational diabetes at first live birth compared to normoglycemia participants (adjusted relative risk [aRR], 2.21; 95% CI, 1.91-2.56). Additionally, preconception prediabetes was linked to an 18% increased risk for both hypertensive disorders of pregnancy (aRR, 1.18; 95% CI, 1.03-1.35) and preterm delivery (aRR, 1.18; 95% CI, 1.02-1.37). While risks for cesarean delivery (aRR, 1.09; 95% CI, 0.99-1.20) and macrosomia (aRR, 1.13; 95% CI, 0.93-1.37) were elevated, they did not reach statistical significance.

The optimal HbA1c threshold for predicting gestational diabetes was identified as 5.6%, which is slightly lower than the adult standard of 5.7%. This threshold was consistent across obesity status but slightly lower for Hispanic participants, with an optimal cut of 5.5%.

The authors noted some limitations, including potential misclassification of covariates and the possibility that the sample may be more representative of a higher-risk population. They concluded that the findings support the need for expanded preconception screening to intervene on excess cardiometabolic risk earlier in the life course.

Full disclosures can be found in the published study.