THE PREGNANT TEENAGER WITH DIABETES - OBSTETRICAL AND SOCIAL RISKS

Study objectives: To provide information on the prevalence of diabetes in pregnancy in women less than 20 years of age; and to compare deliv eries with and without the complication of diabetes in teens and older women with regard to cesarean delivery rate, delivery complications, and selected socioeconomic characteristics. Design, Setting, Participa nts: Hospital claims for the 389,663 admissions for deliveries, ectopi c pregnancies, and abortions from the 69 hospitals with obstetrical se rvices in New Jersey in the years 1984, 1986, 1988. Main Outcome Measu res, Results: Women under 20 accounted for 31,153 (9.9%) of the 314,68 0 hospitalizations for obstetrical deliveries (DRGs 370-375). An ICD-9 -CM code for diabetes mellitus was listed in 180 (0.58%) of teen deliv eries. Of 68,836 hospitalizations for abortion (DRGs 380-381), adolesc ents accounted for 10,140, and of these, 21 (0.2%) had a code for diab etes. Intrauterine fetal death was coded in 1.7% of diabetic and 0.9% of nondiabetic teen deliveries. The cesarean rate was 18% for nondiabe tic teens, 37% for diabetic teens, and 46% for diabetic women aged 20- 45. The complicated-to-uncomplicated ratios for both cesarean and vagi nal deliveries for teens with diabetes were more than six times the ra tios for nondiabetic teens and double those for diabetic older women. Among women who had deliveries, diabetic and nondiabetic adolescent gr oups were similar in percentage of blacks and Hispanics, residence in high perinatal risk geographic area defined by WIC criteria, Medicaid coverage, and self-payment for hospitalization. Conclusions: State-wid e data on adolescent pregnancy complicated by diabetes reveal an incre ased risk of adverse outcomes. The social and medical issues of teenag e pregnancy combined with the problems of a chronic disease call for f urther prospective studies of management alternatives.