Feature Article
PREGNANCY IN ADOLESCENTS WITH TYPE 1 DIABETES
Bronwen G. Brindley, MD
Lois Jovanovic, MD
Sansum Diabetes Research Institute
Santa Barbara, California
Adolescence is a time
of many changes. For an adolescent with type 1 diabetes mellitus (T1DM), change
means becoming more self-reliant in dealing with chronic illness. Rebellion,
acting out, and the desire to be "normal" may drive the adolescent with chronic
disease to make poor choices.1,2 Such choices may have detrimental
effects on dietary intake, medication usage, and social behavior.1,3
For diabetic adolescents, low self-esteem and depression may contribute to
behavior resulting in an unplanned pregnancy. This is of high risk to both the
woman and fetus and is associated with high rates of congenital malformations,
spontaneous abortions, and stillbirths.4,5 Additionally, the
pregnancy can complicate diabetes. Retinopathy and nephropathy may worsen,6,7
and preeclampsia and hypertension of pregnancy occur more frequently.8
However routine physician visits usually focus on the state of the disease
without addressing the sexual habits and/or contraceptive options for
adolescents. Planned pregnancies are not relevant for most teenagers, thus
pregnancy is usually unintended.9,10 Medical intervention usually
begins after embryogenesis and organogenesis,11 and the level of
glycemic control, is often sub optimal at the time of conception and early
development.9,12 This review aims to bring to the attention of
pediatric endocrinologists the importance of this issue.
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Current GGH - Vol. 24 No. 1
