Incidence, Outcomes, and Costs of Pregnancy in Adolescents with and without Diabetes Mellitus
Objective: To analyze and describe the frequency of pregnancy, associated adverse outcomes (pre-eclampsia, preterm delivery, high birthweight, and cesarean delivery), patterns of healthcare utilization, and healthcare expenditures in adolescent pregnancies with and without pre-existing diabetes mellitus. ^ Methods: We conducted a retrospective cohort study analyzing data for female adolescents age 12 to 19 years from 2011 to 2015 using the Truven Health MarketScan® Commercial Claims and Encounters (CCAE) Database. Diabetes exposure and pregnancy outcomes were identified using previously-validated algorithms of diagnostic and procedural codes for claims data. The cohort was limited to women with continuous enrollment for at least twelve months before and two months after the index date of pregnancy. Expenditure and utilization were assessed in the six months before and two months after a live birth. We used a modified version of the Charlson Comorbidity Index to adjust for comorbidities. Outcomes included pre-eclampsia, preterm delivery, high birthweight, cesarean delivery, total payer expenditures. Multivariate logistic regression was used to assess predictors of adverse pregnancy outcomes of interest, with diabetes status as the principal predictor. Multivariate OLS regression was used to assess expenditure as the log-transformed dependent variable and results reported as marginal effects in dollars. ^ Results: Of 5,484,058 female adolescents age 12 to 19 years, 49,669 enrollees had a diagnosis of pregnancy and met our continuous enrollment parameters. Adolescents without diabetes had adverse pregnancy outcomes at rates consistent with national estimates. Adolescent pregnancies with diabetes had substantially elevated odds of adverse pregnancy outcomes compared to peers without diabetes: pre-eclampsia aOR 2.51 [95% CI 2.03-3.11], cesarean delivery aOR 1.79 [1.51-2.12], high birthweight aOR 1.81 [1.48-2.21], and preterm delivery aOR 1.65 [1.35-2.03]. Stratifying diabetes by the presence of diabetic complications, we found substantially increased odds of pre-eclampsia, preterm delivery, and cesarean delivery in adolescent pregnancies with complicated diabetes. More frequent utilization of outpatient and inpatient care as well as significantly higher payer expenditures was evident in adolescent pregnancies with pre-existing diabetes. The marginal effect on total expenditures attributable to diabetes exposure was $6,573 ± 1,050 (uncomplicated diabetes: $6,126 ± 978 vs. diabetes complicated by ketoacidosis or end-organ damage: $11,116 ± 1,775). ^ Conclusion: Pregnancy is not uncommon among female adolescents with diabetes. Pre-existing diabetes during an adolescent pregnancy places the mother at substantially increased risk of pre-eclampsia, cesarean delivery, preterm delivery, and delivery of a high birthweight neonate. Diabetes results in significant additional healthcare utilization and financial expense for the payer during adolescent pregnancy.^
Kohn, Jaden R, "Incidence, Outcomes, and Costs of Pregnancy in Adolescents with and without Diabetes Mellitus" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10815326.