The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D).
Methods
Using a mental model approach, a panel of experts— representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health—was convened to discuss reproductive health issues for female adolescents with T2D.
Results
Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one’s lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management.
Conclusions
Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.
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References
1.
Morgan MG, Fischhoff B., Bostrom A., Atman C.Risk Communication: The Mental Models Approach. New York, NY: Cambridge University Press; 2001.
2.
LaMone P.Human sexuality in adults with IDDM. Image J Nurs Sch. 1993;25:101-106.
3.
Poirier L., Coburn K.Women & Diabetes: Life Planning for Health & Wellness. Alexandria, VA: American Diabetes Association ; 1997.
4.
Kitzmiller JL , Buchanan TA, Kjos S., Combs CA, Ratner REPreconception care of diabetes, congenital malformations, and spontaneous abortions. Diabetes Care. 1996;19:514-541.
5.
Kitzmiller JL , Gavin LA, Gin GD, Jovanovic-Peterson L., Main EK, Zigrang WDPreconception care of diabetes: glycemic control prevents congenital anomalies . JAMA. 1991;256:731-736.
6.
Elixhauser A. , Weschler JM, Kitzmiller JL, et al. Cost-benefit analysis of preconception care of women with established diabetes mellitus . Diabetes Care. 1993;16:1146-1157.
7.
Combs C., Kitzmiller J.Spontaneous abortions and congenital malformations in diabetes. Baillières Clin Obstet Gynaecol. 1991;5:315-331.
8.
Nankervis A, Werther GA, Court JM, eds. Sexual Function and Pregnancy , in Diabetes and the Adolescent. Melbourne , Australia: Miranova; 1998.
9.
Schroeder B. , Hertweck S., Sanfilippo J., Foster MBCorrelation between glycemic control and menstruation in diabetic adolescents. J Reprod Med. 2000 ;45:1-5.
10.
Mills J., Baker L., Goldman A.Malformations in infants of diabetic mothers occur before the seventh gestational week. Diabetes. 1979:28:292-293.
11.
Miller E., Hare JW, Cloherty JP, et al. Elevated maternal hemoglobin A1, in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med. 1981;304:1331-1334.
12.
American Diabetes Association.Preconception care of women with diabetes. Diabetes Care. 2004;27:S76-S78.
13.
Cousins L.The California diabetes and pregnancy program: a statewide collaborative program for the preconception and prenatal women. Baillières Clin Obstet Gynaecol. 1991:5:443-460.
14.
Willhoite MB , Bennert HW, Palomaki GE, et al. The impact of preconception counseling on pregnancy outcomes: the experience of the Maine Diabetes in Pregnancy Program . Diabetes Care. 1993:16:450-455.
15.
Michel B., Charron-Prochownik D.Diabetes nurse educators and preconception counseling. Diabetes Educ. 2006;32:108-116.
16.
Charron-Prochownik D., Sereika SM, Wang SL, et al. Reproductive health and preconception counseling awareness in adolescents with diabetes: what they don’t know can hurt them. Diabetes Educ. 2006;32:235-242.
17.
Charron-Prochownik D., Hannan MF, Sereika SM, Becker D., Rodgers-Fischl A.How to develop CD-ROMs for diabetes education: exemplar "Reproductive-health Education and Awareness of Diabetes in Youth for Girls" (READY-Girls). Diabetes Spectrum . 2006;19:110-115.
18.
Betchart-Roemer J.Type 2 Diabetes in Teens. New York, NY: John Wiley & Sons; 2002.
19.
Court JM, Cameron FJ, Berg-Kelly K., Swift PGF.Diabetes in adolescence. Pediatr Diabetes. 2008;9:255-262.
20.
Pinhas-Hamiel O., Zeitler P.The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005 ;146:693-700.
21.
Rosenbloom A., Joe JR, Young R., Winter W.Emerging epidemic of type 2 diabetes in youth . Diabetes Care. 1999;22:345-354.
22.
American Diabetes Association.Increasing incidence of type 2 diabetes in the third millennium: is abdominal fat the central issue? Diabetes Care. 2000;23:441-442.
23.
American Diabetes Association.Type 2 diabetes in children and adolescents. Diabetes Care . 2000;23;381-389.
24.
Beckles GLA, Thompson-Reid PE, eds. Diabetes and Women’s Health Across the Life Stages: A Public Health Perspective. Atlanta, GA; US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation; 2001.
25.
Fischhoff B. , Bruine de Bruin W., Güvenç Ü., Caruso D., Brilliant L.Analyzing disaster risks and plans: an avian flu example. J Risk Uncertain. 2006;33:131-149.
26.
Bruine de Bruin W., Downs JS, Fischhoff B.Adolescents’ thinking about the risks and benefits of sexual behavior . In: Lovett M, Shah P, eds. Thinking With Data. Mahwah, NJ : Erlbaum;2007.
27.
Downs JS, Murray PJ, Bruine de Bruin W., Penrose J., Palmgren C., Fischhoff B.Interactive video behavioral intervention to reduce adolescent females’ STD risk: a randomized controlled trial. Soc Sci Med. 2004;59:1561-1572.
28.
Fischhoff B. , Downs JSAccentuate the relevant. Psychol Sci. 1997 ;8:154-158.
29.
Fischhoff B. , Riley D., Kovacs DC, Small M.What information belongs in a warning? A mental models approach. Psychol Market. 1998;15:663-686.
30.
Clemens RTMaking Hard Decisions: Introduction to Decision Analysis. Belmont, CA: Duxbury; 1997.
31.
Merz J., Fischhoff B., Mazur DJ, Fischbeck PSDecision-analytic approach to developing standards of disclosure for medical informed consent. Journal of Toxics and Liability . 1993;15: 191-215.
32.
Becker MH, Rosenstock JMComparing social learning theory and the health belief model. In: Ward WB, ed. Advances in Health Education and Promotion. Greenwich, CT: JAI Press;1987:45-249.
33.
Janz NK, Herman WH, Becker M., et al. Diabetes and pregnancy: factors associated with seeking preconception care. Diabetes Care. 1995;18:157-165.
34.
Kirby D.Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing. J Sex Res. 2002;39:51-57.
35.
Kaestle CE, Morisky DE, Wiley DJSexual intercourse and the age difference between adolescent girls and their romantic partners. Perspect Sex Reprod Health. 2002;34:304-309.
36.
Rosenbloom AL , Silverstein JHType 2 Diabetes in Children & Adolescents . Alexandria, VA: American Diabetes Association; 2003.
37.
Hemachandra A., Ellis D., Lloyd CE, Orchard TJThe influence of pregnancy on IDDM complications . Diabetes Care. 1995;18: 950-955.
38.
Holcomb WL, Mostello DJ, Leguizamon G.African-American women have higher initial HbA1c levels in diabetic pregnancy . Diabetes Care. 2001;24:280-283.
39.
Arslanian S.Metabolic differences between Caucasian and African American children and the relationship to type 2 diabetes mellitus . J Pediatr Endocrinol Metab. 2002;15;509-517.
40.
Arslanian S. , Saad R., Lewry V., et al. Hyperinsulinemia in African American children: decreased insulin clearance and increased insulin secretion and its relationship to insulin sensitivity. Diabetes . 2002;51:3014-3019.
41.
Reverby S.History of an apology: from Tuskegee to the White House. Research Practice. 2000;8:1-12.
42.
Taylor J., Franklin A.Psychosocial analysis of black teenage pregnancies: implications for public and cultural policies. Policy Stud Rev. 1994 ;13:157-164.
43.
Lowry R., Kann L., Collins JL, Kolbe L.The effects of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA. 1996;276:792-797.
44.
Alberti G., Zimmet P., Shaw J., et al. Type 2 diabetes in the young: the evolving epidemic. Diabetes Care. 2004;27:1798-1811.
45.
Vivian E.Type 2 diabetes in children and adolescents-the next epidemic? Curr Med Res Opin. 2006;22:297-306.
46.
Akers A., Lynch C., Gold M., et al. Exploring the relationship between obesity and sexual risk behaviors among female adolescents. J Adolesc Health. 2008;42:45-46.
47.
Apter D., Vihko R.Early menarche, a risk factor or breast cancer, indicates early onset of ovulatory cycles. J Clin Endocrinol Metab. 1983;57:82-86.
48.
Doswell W., Braxton B.Risk-taking behaviors in early adolescent minority women: implications for research and practice. J Obstet Gynecol Neonatal Nurs . 2002;4:31.
49.
Doswell WMThe NIA group: building a sense of purpose in preadolescent African American girls. Nurs Leadersh Forum. 2004;8;95-100.
50.
Doswell W., Millor G., Thompson H.Self-image and self-esteem in African-American preteen girls: implications for mental health. Issues Ment Health Nurs. 1998;19:71-94.
51.
Doswell W., Kouyate M., Taylor J.Spirituality: a missing piece in preventive medicine: the health of African American adolescent girls and early sexual behavior. Am J Health Stud. 2003;18:195-202.
52.
Doswell W., Kitutu J., McHenry B.The use of theoretical models to examine early sexual behavior in African American adolescent girls. Journal of Chi Eta Phi . 2004;50:15-20.
53.
Finer LB, Henshaw SKDisparities in rates of unintended pregnancy in the United States . Perspect Sex Reprod Health. 2006;38:90-96.
54.
Zisser H.Polycystic ovary syndrome and pregnancy: is metformin the magic bullet ? Diabetes Spectrum. 2007;20:85-89.
55.
Langer O.Oral antidiabetic drugs in pregnancy: the other alternative. Diabetes Spectrum. 2007;20:101-105.
56.
Herman WH, Janz NK, Becker MP, Charron-Prochownik D.Diabetes and pregnancy: preconception care, pregnancy outcomes, resource utilization and costs. J Reprod Med. 1999;44:33-38.
57.
Herman W., Charron-Prochownik D.PC: an opportunity not to be missed. Clin Diabetes . 2000;18:122-123.
