Menstrual Dysfunction in Adolescents with Chronic Illness: A Systematic Review

Study ObjectiveMenstrual dysfunction can impact both the physical and emotional health of young people.¹ Multiple chronic diseases have been associated with menstrual dysfunction in adults²; however, there is little research in adolescents, despite nonadherence and suboptimal illness control in this group. We aimed to identify the impact of chronic illness on the age of menarche and the menstrual cycle in adolescents.MethodsStudies were extracted of female adolescents aged 10-19 who had a chronic physical illness. Data included outcomes on age of menarche and/or menstrual cycle quality. Exclusion criteria aimed to exclude diseases where menstrual dysfunction was a known part of the disease pathophysiology (ie, polycystic ovarian syndrome)³ or in which medications were used that directly impacted gonadal function.⁴ A literature search (to January 2022) was performed on the EMBASE, PubMed, and Cochrane library databases. Two widely used modified quality analysis tools were used.ResultsOur initial search netted 1451 articles, of which 95 full texts were examined and 43 met the inclusion criteria. Twenty-seven papers focused on type 1 diabetes (T1D), with 8 papers examining adolescents with cystic fibrosis and the remaining studying inflammatory bowel disease, juvenile idiopathic arthritis, coeliac disease, and chronic renal disease. Metanalysis of 933 patients with T1D vs 5244 controls demonstrated a significantly later age of menarche in T1D (by 0.42 years; P ≤ .00001). There was also a significant association between higher HbA1c and insulin dose (IU/kg) and later age of menarche. Eighteen papers reviewed other aspects of menstruation, including dysmenorrhea, oligomenorrhoea, amenorrhea, and ovulatory function, with variable findings.ConclusionMost studies were small and in single populations. Despite this, there was evidence of delayed menarche and some evidence of irregular menses in those with cystic fibrosis and T1D. Further structured studies are needed to evaluate menstrual dysfunction in adolescents and how it relates to their chronic illness.     

The effects of vitamin D supplementation on indices of glycemic control in Iranian diabetics: A systematic review and meta-analysis

Background and purposeThis systematic review and meta-analysis aimed to assess the effects of vitamin D supplements on indices of glycemic control [homeostatic model assessment-insulin resistance (HOMA-IR), hemoglobin A1C (HbA1C), fasting blood glucose (FBG), and quantitative insulin-sensitivity check index (QUICKI) and lipid profile in diabetic patients.MethodsEight databases were searched, for randomized controlled trials (RCTs) or cross-sectional and cohort studies that have been published up to December 2017. We used the comprehensive meta-analysis (CMA) software for all statistical analysis and used the I² index for assessing heterogeneity. A p value of <0.05 was considered as statistically significant.ResultsWe found 621 articles, and after the exclusion of ineligible publications, 82 studies remained to be assessed of which 37 were used for meta-analysis. Vitamin D supplementation was associated with a significant improvement in FBG (p = 0.001 and 95% CI: −0.526 to −0.136) and HbA1C (p = 0.003 and 95% CI: 1.719 to −0.361) in individuals with type 2 diabetes mellitus (T2DM); while in women with gestational diabetes mellitus (GDM) the reduction in FBG (p = 0.071 and 95% CI: −0.873 to −0.035) and HbA1C (p = 0.199 and 95% CI: 3.270 to 0.681) failed to reach statistical significance. Treatment with vitamin D supplements was associated with an improvement in HOMA-IR in pregnant diabetic women (p = 0.028 and 95% CI: 0.924 to −0.053) and for individuals with diabetes mellitus (p = 0.005 and 95% CI: 1.772 to −0.319). The pooled result of the cross-sectional meta-analysis indicated that serum vitamin D concentrations were significantly lower in diabetic patients than in healthy controls (p = 0.018 and 95% CI: 0.587 to −0.054).ConclusionThis meta-analysis suggests that vitamin D supplementation improves indices of glycemic control (FBG, HOMA-IR, and HbA1C) in patients with diabetes mellitus. Hence, vitamin D supplements may be of potential therapeutic value in diabetic patients, as an adjuvant therapy along with other treatments.     

Use of Digital Media Technology for Primary Prevention of STIs/HIV in Youth

Study ObjectiveThe relevant literature was reviewed to identify issues in research evaluating digital media technology (DMT) interventions for the primary prevention of STIs/HIV in adolescents and young adults.MethodA literature search with relevant key terms was conducted in PubMed, for articles with studies that included: (a) participants between 11-29 years; (b) use of one or more of the following forms of DMT: interactive digital video or CD-ROM, computer, text messaging, or Internet; (c) evaluation of an STI/HIV primary prevention intervention; and (d) use of a cognitive, psychosocial, behavioral, or biological outcome.ResultsTwenty-nine studies were identified and included in the review. Based on the review of these studies, 7 main issues were discussed and recommendations for improving future research were offered. The 7 main issues were: (a) need for a balance between universal application and specific sub-group focus, (b) lack of a developmental framework, (c) challenge of applying DMT in resource limited contexts, (d) rapidly changing nature of DMT, (e) lack of biological outcomes, (f) lack of comparison/control groups to assess the impact of DMT, and (g) limited temporal follow-up.ConclusionsThere is increasing literature evaluating the effectiveness of DMT for preventing STIs/HIV among adolescents and young adults. A careful consideration of 7 main issues identified in the literature can improve the design and evaluation of these interventions and enhance our understanding of their effectiveness.     

Association of Glycemic Control with Risk of Erectile Dysfunction in Men with Type 2 Diabetes

IntroductionImprovement in glycemic control is likely to reduce the risk of diabetic complication, while its effect on erectile dysfunction (ED) remains unclear.AimThe aim of this study was to evaluate the association of glycemic control with risk of ED in type 2 diabetics.MethodsA self-administered questionnaire containing Sexual Health Inventory for Men was obtained from 792 subjects with type 2 diabetes at our institution. Clinical data were obtained through chart review.Main Outcome MeasuresThe contribution of glycemic control assessed by glycated hemoglobin (HbA_1c) level as well as age, duration of diabetes, hypertension (HT), dyslipidemia, and cigarette smoking to risk of ED was evaluated.ResultsOf 792 subjects, 83.6% reported having ED and 43.2% had severe ED. HbA_1c level (%) adjusted for age and duration of diabetes was significantly associated with ED (OR 1.12, 95% CI: 1.01–1.25). None of HT, dyslipidemia, and cigarette smoking was a significant risk factor for ED after adjusted for age and duration of diabetes. HbA_1c level, age, and duration of diabetes were significant independent risk factors for ED among the younger group (age ≤ 60 years), and only age and duration of diabetes were independent risk factors among the older group (age > 60 years). For the risk of severe ED, compared with no and mild to moderate ED, HbA_1c level, duration of diabetes, and HT were independent risk factors among the younger group, and only age was an independent factor among the older group.ConclusionsBetter glycemic control probably would reduce the prevalence of ED and its severity among the younger men with type 2 diabetes. For the older group, aging was the major determinant for ED risk among this population with type 2 diabetes. Lu C-C, Jiann B-P, Sun C-C, Lam H-C, Chu C-H, Lee J-K. Association of glycemic control with risk of erectile dysfunction in men with type 2 diabetes.     

The Association between Childhood Adversity and Risk of Dysmenorrhea,Pelvic Pain,and Dyspareunia in Adolescents and Young Adults: A Systematic Review

PurposeExposure to adverse childhood experiences (ACEs) has been associated with poor health outcomes, including chronic pain. However, little is known about the potential impact on the development of pelvic pain in adolescents and young adults. This systematic review was conducted to explore the association between ACEs and dysmenorrhea, pelvic pain, and dyspareunia in adolescents and young adults.MethodsMedline, Embase, and PsycNET were searched, using keywords related to childhood adversity, dysmenorrhea, pelvic pain, and dyspareunia.ResultsOf the 566 articles identified, 19 studies were included. There was an association between the number and severity of ACEs and the risk of dysmenorrhea. Sexual abuse and posttraumatic stress disorder appeared to be associated with dysmenorrhea, pelvic pain, and dyspareunia, but it was unclear whether this relationship was mediated by poorer mental health. No association was found for immigration and bullying, and findings were inconsistent regarding female genital mutilation, parental separation, and parental death.ConclusionsFuture research should include longitudinal follow-up and use validated tools to assess childhood adversity. A greater understanding of the risk of ACEs among adolescents and young adults with dysmenorrhea, chronic pelvic pain, and dyspareunia could provide insight into the development of these conditions.     

Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases

BackgroundFemale sexual dysfunctions (FSDs) are frequent concerns in women with type 1 diabetes (T1D), which is frequently associated with other autoimmune diseases (ADs).AimTo assess sexual function in young type 1 diabetic women with or without additional ADs.MethodsWomen with T1D aged 18–35 years with a stable couple relationship and no oral contraceptive use were enrolled. Diabetic women with concomitant ADs were also identified. All women completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale.OutcomesThe main outcome was the prevalence of FSD. The FSFI-single domain scores were also evaluated in diabetic women with or without additional ADs.ResultsThe global population included 154 diabetic women, of whom 66 (42%) had at least one additional AD. The prevalence of FSD was similar among diabetic women with and those without (30% vs 32%, P = .980) additional ADs. The FSFI-desire score was significantly lower among diabetic women with concomitant ADs than those without ADs [median (interquartile range), 4.1 (3.6, 4.8) vs 4.6 (4.0, 5.0), P = .042].Clinical ImplicationsAn early evaluation of sexual function in women with T1D and concomitant ADs should be encouraged.Strengths & LimitationsMajor strengths are the use of 2 validated tools to diagnose FSD and the relatively large number of subjects investigated. The limitations include the cross-sectional nature of the study, which does not allow to make inference regarding the cause and effect.ConclusionDiabetic women with additional ADs show an impairment in sexual desire as compared with those suffering only from diabetes.Longo M, Cirillo P, Scappaticcio L, et al. Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases. J Sex Med 2021;18:219–223.     

A Review of the Health Beliefs and Lifestyle Behaviors of Women with Previous Gestational Diabetes

ObjectiveTo critically review and synthesize original research designed to examine the health beliefs, including risk perceptions and health behaviors related to diet and physical activity of women with previous gestational diabetes mellitus.Data SourcesPubMed and CINAHL databases were searched for studies published in the last decade (1998-2008) that examined variables related to the health beliefs and behaviors of women with previous gestational diabetes mellitus. Keyword searches included health beliefs, health behaviors, perceived risk, gestational diabetes, type 2 diabetes, diet, physical activity, and postpartum.Study SelectionEight articles, representing 6 studies, were selected that met the inclusion criteria of original research, dependent variable of health beliefs and behaviors of women with previous gestational diabetes mellitus, and measurement after pregnancy.Data ExtractionArticles were reviewed and discussed according to the concepts of risk perception and health beliefs, health behaviors related to diet and physical activity, and psychosocial factors related to women's health beliefs and behaviors.Data SynthesisData revealed common health beliefs and behaviors of women with previous gestational diabetes mellitus, including low risk perceptions for future type 2 diabetes mellitus and suboptimal levels of physical activity and fruit and vegetable intake. The majority of studies revealed a distinct knowledge-behavior gap among women with previous gestational diabetes mellitus, whereas others revealed a lack of knowledge regarding necessary lifestyle modifications.ConclusionsFindings from this review may assist women's health researchers and clinicians in developing appropriate interventions for increasing risk awareness, promoting self-efficacy for weight loss and physical activity behaviors, and decreasing rates of diabetes and cardiovascular disease among women with previous gestational diabetes mellitus. Further research is necessary to identify factors that influence the health beliefs and behaviors of women with previous gestational diabetes mellitus. Future research should focus on populations of greater racial, ethnic, and socioeconomic diversity, as the majority of studies have been conducted with non-Hispanic White, socioeconomically advantaged women.     

Effectiveness of Contraceptive Decision Aids in Adolescents and Young Adults: A Systematic Review

BackgroundContraceptive decision aids may support adolescents and young adults (AYA) in choosing contraceptive methods that fit their unique reproductive health needs.ObjectiveTo provide a systematic review of studies examining the effectiveness of contraceptive decision aids in AYA.Materials and MethodsA systematic search was conducted of studies published between January 1, 2011, and March 31, 2021 using PubMed, Cochrane, and ClinicalTrials.gov. Studies were included if a contraceptive decision aid (ie, paper handout, mobile application, website, or video) was evaluated in AYA populations (age ≤30 years) in the United States. The primary outcome was decision aid effectiveness (ie, change in contraceptive knowledge, interest in contraception, contraceptive use, unintended pregnancies, and satisfaction with the decision aid).ResultsSeven randomized controlled trials and 3 pre?post studies, reporting on 3725 AYA (range, 11-30 years), met inclusion criteria. No studies were excluded due to risk of bias. The methodologies and results were heterogeneous, but most consistently demonstrated increased contraceptive knowledge.ConclusionTen studies evaluated a range of contraceptive decision aid formats for AYA. Decision aids appear to be effective at increasing contraceptive knowledge temporarily, but their effect on other contraceptive outcomes is unclear. Future research should evaluate decision aids specifically in adolescents.     

Adolescents,Pregnancy, and Mental Health

Study ObjectivePregnancy during adolescence is a risk factor for adverse medical and psychosocial outcomes, including psychiatric illness. Psychiatric illness is linked with obstetric complications along with impaired maternal functioning in the postpartum period. This article provides a comprehensive review of the research examining the intersection of psychopathology and adolescent pregnancy and the postpartum period.DesignA literature search was conducted using PubMed (Medline), PsycINFO, and CINAHL for articles published between 1990 and 2013 that examined depression, anxiety, bipolar disorder, and psychosis during pregnancy and the postpartum period in adolescents age 21 years or younger. Articles were selected that covered the following topics: Prevalence or incidence, comorbidity, psychosocial correlates, birth outcomes, parenting, child outcomes, and psychosocial treatment. Forty articles were found and reviewed.ResultsThere is a substantial research base examining self-reported depressive symptoms in adolescents during pregnancy and the postpartum period. Existing research suggests that pregnant and parenting adolescents are at greater risk for experiencing depressive symptoms than pregnant and postpartum adult women. Depression in the perinatal period is also a risk factor for substance and alcohol abuse and a harsher parenting style in adolescents. Areas for future research in this population include investigating the prevalence, psychosocial correlates, and outcomes of clinically diagnosed Major Depressive Disorder, developing and empirically validating psychotherapeutic treatments, and focusing upon other psychiatric diagnoses such as bipolar disorder, anxiety, and psychosis.     

Providing Contraceptive Health Services to Adolescents and Young Adults by Telemedicine: A Scoping Review of Patient and Provider Perspectives

ObjectiveThe objective of this scoping review is to synthesize and identify gaps in existing research on accessibility of telemedicine-delivered contraceptive health services to female adolescents and young adults (AYAs) and acceptability of these services to AYA patients and their medical providers.MethodsWe searched the PubMed, Scopus, Embase, and CINAHL databases to extract relevant studies on telemedicine and provision of contraceptive services among non-institutionalized, non-chronically ill female AYAs, ages 10 through 24 years.ResultsWe screened 154 articles, and 6 articles representing 5 studies met the full inclusion criteria. Three studies assessed telemedicine acceptability and accessibility from the perspective of providers, and 3 described patients’ perceived accessibility and acceptability of a theoretical telemedicine visit. No studies directly assessed AYA patients’ satisfaction with actual telemedicine visits for contraceptive services. Providers viewed telemedicine-delivered sexual and reproductive health (SRH) services as acceptable to themselves and AYA patients. Most AYAs reported that they would use telemedicine for SRH services, although they would prefer in-person care. All articles identified concerns about privacy and confidentiality as a barrier to SRH telemedicine care.ConclusionsTelemedicine-delivered contraceptive health services for AYAs were perceived as acceptable and accessible by providers and by most AYA patients, although patients reported a preference for in-person care. However, none of these findings are based on patients’ actual experiences with SRH telemedicine. Further research is needed to directly assess the accessibility and acceptability of telemedicine-delivered contraceptive health services for female AYA patients.     

Comparing Pregnancy in Adolescents and Adults: Obstetric Outcomes and Prevalence of Anemia

ObjectiveTo characterize the obstetric outcome and prevalence of anemia in primiparous adolescents and compare them with those in older primiparas.MethodsWe conducted a retrospective chart review of 207 adolescents (≤ 19 years old) and 415 adults (≥ 20 years old) whose prenatal care was provided by a single obstetrician in Kingston, Ontario, and who had a live singleton birth at ≥ 24 weeks’ gestation between 1996 and 2004.ResultsThe mean age of the adolescents (T) was 17.5 years and of the adults (A) 27.3 years. More than 95% of the women were Caucasian. Mean gestational age at delivery was similar in the two groups (T 39.4 weeks, A 39.6 weeks, P = 0.25). Adolescents were more likely to have a preterm delivery (T 12.6%, A 7.5%, P = 0.038), although smoking rather than young maternal age was an independent risk factor for preterm delivery (odds ratio [OR] 3.2; 95% confidence intervals [CI] 1.4–7.5). A significantly lower proportion of adolescents delivered by Caesarean section (CS) (T 12.1%, A 27.7%, P < 0.001). Older maternal age, higher pre-pregnancy BMI, increased weight gain during pregnancy, and pre-delivery anemia were all independent risk factors for CS. Smoking was the most influential factor in predicting infant birth weight. Adolescents had significantly more low birth weight infants (< 2500 g) than adults (T 10.1% vs. A 4.3%, P = 0.008). Gestational age rather than young maternal age was the most significant risk factor for low birth weight (OR 3.3; 95% CI 1.9–5.7). After controlling for smoking status, adolescents were 2.5 times more likely than adults to be anemic at 26 to 35 weeks’ gestation and pre-delivery.ConclusionOur results suggest that primiparous adolescents have significantly different obstetric outcomes from primiparous adults. Smoking and anemia are significant risk factors for poor obstetric outcomes and are potentially modifiable.     

Premature Ejaculation Is Associated with Glycemic Control in Type 1 Diabetes

IntroductionPremature ejaculation (PE) is the most common male sexual dysfunction. Its prevalence in Type 1 diabetes is unknown.AimThe aim of this study was to assess the prevalence of PE in Type 1 diabetes and the influence of glycemic control on ejaculatory function.MethodsOne hundred Type 1 diabetic male patients (age < 40 years) and 51 age-matched nondiabetic control subjects were evaluated for PE. A subgroup of 30 diabetic patients (20 with PE and 10 without) were also evaluated for blood glucose variability.Main Outcome MeasuresThe presence of PE was assessed with the premature ejaculation diagnostic tool (PEDT) and the self-estimated intravaginal ejaculatory latency time (IELT). Glucose variability was evaluated by continuous glucose monitoring for a 7-day period with a DexCom G4 CGM system: the mean amplitude of glycemic excursions (MAGEs), low (LBGI) and high (HBGI) blood glucose indices, and the standard deviation of blood glucose (BGSD) were calculated.ResultsPE prevalence did not differ significantly between the two groups: pathological values of the PEDT score (>8) and IELT score (<1 minute) were recorded in 24 out of 100 diabetic patients (24%) and in 12 out of 51 controls (23.5%). There were significant associations between hemoglobin A1c and the PEDT score (r = 0.27; P = 0.006) and IELT (r = −0.3; P = 0.01). In the subgroup assessed for glucose variability, the PEDT score was associated with LBGI (r = 0.43; P = 0.01), but not with BGSD (r = 0.1, P = 0.6), MAGE (r = −0.1; P = 0.4), or HBGI (r = 0.1; P = 0.6).ConclusionsOur results show a similar prevalence of PE in young male patients with Type 1 diabetes and in the age-matched control population; in diabetic patients with PE, a higher glycemic variability in the hypoglycemic domain is significantly associated with the PEDT score. Bellastella G, Maiorino MI, Olita L, Della Volpe E, Giugliano D, and Esposito K. Premature ejaculation is associated with glycemic control in Type 1 diabetes. J Sex Med 2015;12:93–99.     

Perinatal outcomes in pregnancies complicated by type 1 diabetes mellitus

Abstract

The aim of this study was to explore the risk of perinatal outcomes in pre-gestational type 1 diabetes mellitus (T1DM) compared to gestational diabetes mellitus (GDM) and pregnancy without diabetes and to examine the association of glycemic level of third-trimester gestation with perinatal outcomes in T1DM. We included 69 pre-gestational T1DM, 1398 cases of GDM, and 1304 control pregnancies and collected data regarding demographics, obstetric, and perinatal outcomes from the hospital discharge database. Relative to the pregnancies without diabetes, women with T1DM encountered increasing risk of polyhydramnios, preterm delivery, and cesarean section. These adverse outcomes were also common in GDM, although with relatively lower adjusted ORs. The weights of babies delivered by women with T1DM were more intend to be large for gestational age, as well as to be less than 2.5?kg relative to those without diabetes. Poorly controlled hemoglobin A1c in late pregnancy was significantly associated with an increased risk of preterm birth in T1DM (adjusted odds ratio 2.01, 95%confidence interval 1.1–3.6). Women with T1DM have considerably increased risks of adverse perinatal outcomes, which appear more prevalent than the perinatal outcomes in women with GDM. Thus, a specific routine is required for pregnancy in T1DM to improve the glycemic control and obstetric care.     

Testing and Treatment for Sexually Transmitted Infections in Adolescents—What's New?

BackgroundSignificant changes are taking place in the diagnosis and management of sexually transmitted infections (STI) in adolescents and young adults.FindingsIn this review article, we provide an update of STIs in adolescents and young adults including: (1) Adolescent risk; (2) Screening guidelines; (3) Clinical manifestations; (4) Diagnostic testing; (5) Treatment; and (6) Prevention; with an emphasis on “what’s new” in the field.Conclusions/SignificanceWhile the impacts of STI epidemiology and health care access are leading to new recommendations for screening and prevention, changes in technology and drug resistance are promoting new methods of STI testing and ongoing revisions of STI treatment recommendations.     

The prevalence of congenital malformations is still higher in pregnant women with pregestational diabetes despite near-normal HbA1c: a literature review

Aims/hypothesis: We assessed the association between congenital malformations and maternal hyperglycemia in pregnant women with pregestational (type 1 or type 2) diabetes and investigated if the rate of congenital malformations was similar in women with near-normal glycemic control compared to the background population. We also assessed the association between congenital malformations and maternal hyperglycemia in pregnant women with pregestational diabetes with special focus on women with near-normal HbA1c in early pregnancy.

Materials and methods: This is a literature review based on an electronic literature search of the databases PubMed, Cochrane, Embase and Web of Science conducted in July 2017 using the search terms diabetes, pregnancy, HbA1c or glycemic control and congenital anomaly or congenital anomaly. We included original papers in English published after 1997 with data on congenital malformations and HbA1c in at least 250 women with pregestational diabetes.

Results: Nine papers with in total 6225 women with type 1 diabetes and 2334 women with type 2 diabetes were included. The prevalence of congenital malformations was 6.4% in women with type 1 diabetes and 4.3% in women with type 2 diabetes and for the combined group of women with pregestational diabetes, the relative risk compared to the background population was 3.2. In women with HbA1c?Conclusions: In pregnant women with pregestational diabetes the prevalence of congenital abnormalities was threefold higher in women with pregestational diabetes compared to the background population. However, HbA1c below 53?mmol/mol (7.0%) in early pregnancy was also associated with a two times increased risk of congenital malformations compared to the background population.     

Prematurity and Low Birth Weight among Brazilian Adolescents and Young Adults

Study ObjectiveTo compare the incidence of preterm birth and low birth weight infants in young and older primiparous adolescents versus young adults.DesignCross-sectional study.SettingMaternity hospital in Vitória, ES, Brazil.ParticipantsDuring a 5-year period, young primiparous women who delivered a singleton liveborn infant over 22 weeks were interviewed while in the postpartum ward.InterventionsA single investigator performed all the individual interviews to collect sociodemographic variables and obtained gestational age and birth weight from the patients' charts before discharge.Main Outcome MeasuresParticipants were divided into 3 groups according to age: young adolescents (10–15 years), older adolescents (16–19 y) and young adults (20–24 y). The χ² test was used to compare the rate of preterm birth and low birth weight between the groups and analyze differences in sociodemographic characteristics between the 3 groups. P < 0.05 was considered significant.ResultsA total of 1124 participants were included: 164 young adolescents, 537 older adolescents and 423 adults. The rate of preterm birth was similar in the 3 groups: 4.3%, 3.5% and 4.5%, for young adolescents, older adolescents and adults, respectively (P = 0.48). The rate of low birth weight was significantly higher among young adolescents (9.7%) compared to older adolescents (6.1%) and young adults (3.5%) (P = 0.012).ConclusionsThe rate of preterm birth was similar in adolescents and young adults. Adolescent mothers under 16 years of age have a significantly higher incidence of low birth weight infants.     

Age at Menarche and Menstrual Irregularities of Adolescents with Type 1 Diabetes

Study ObjectiveThe aim of the study was to investigate the age at menarche and menstrual irregularities in adolescents with type 1 diabetes.DesignThis was an aged-matched, controlled study.SettingThe study was done in the diabetes center of a children's hospital in Athens and in high schools in major regions of central Greece.ParticipantsThe study involved two groups: a group of 100 female adolescents, 12 to 18 years of age, with type 1 diabetes; and a control group of 225 healthy adolescents, matched for age.Main Outcome MeasuresThe relationship between age at menarche and menstrual irregularities was studied.ResultsThe mean age at menarche differed significantly in the two groups (P = 0.000). In particular, the mean age at menarche in the study group was 12.2 years (± 1.4) and in the control group it was 11.7 years old (± 1.2). The mean age of menarche was older in the subgroup of adolescents who had received a diagnosis of diabetes before the age of 10 than it was in those diagnosed after the age of 10.ConclusionsMenarche was observed to be delayed in adolescents with type 1 diabetes who had been diagnosed before the age of 10 in comparison with those diagnosed after the age of 10. Menstrual irregularities were found to be more common in adolescents with type 1 diabetes than in healthy ones.     

Risk factors,pregnancy complications,and prevention of hypertensive disorders in women with pregravid diabetes mellitus

Objective: To review the rate, risk factors, and potential prevention of preeclampsia in women with pregravid diabetes mellitus.

Methods: Detailed review of recent English literature describing pregnancy outcome in women with pregravid insulin-dependent diabetes mellitus (Type 1 diabetes). The primary focus of the review is risk factors for preeclampsia and potential methods suggested for prevention of preeclampsia. In addition, pitfalls in diagnosis of preeclampsia will be emphasized.

Results: The reported rate of preeclampsia ranged from 9% to 66%. This rate increased with increased severity of diabetes by White's classification, with the highest rate reported in women with pregravid diabetic nephropathy. Risk factors identified for preeclampsia were nulliparity, chronic hypertension, microalbuminuria prior to pregnancy, nephropathy, and poor glycemic control early in pregnancy. There is lack of agreement among reports in the literature concerning criteria used to diagnose preeclampsia. There are two randomized trials that included women with Type 1 diabetes who were randomized to receive either low-dose aspirin or placebo. There was no reduction in the rate of preeclampsia with low-dose aspirin in either trial.

Conclusions: In women with pregravid Type I diabetes, the rates of preeclampsia and adverse neonatal outcome increase with increased severity of diabetes. Low-dose aspirin does not reduce rate of preeclampsia in such women. Further studies should address the role of good glycemic control prior to 20 weeks gestation and prevention of microalbuminuria.     

Outcomes of a Mindfulness-Based Healthy Lifestyle Intervention for Adolescents and Young Adults with Polycystic Ovary Syndrome

Study ObjectiveThe purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mindfulness-based healthy lifestyle self-management intervention with adolescents and young adults diagnosed with polycystic ovary syndrome (PCOS).DesignA pilot randomized controlled trial using a pre-post design was used.SettingCentral Texas. Participants: Individuals aged 14–23 with a diagnosis of PCOS.InterventionsThe PCOS Kind Mind Program integrates a manualized mindfulness training program (Taming the Adolescent Mind) with health education in 4 key areas of self-management and health promotion: (1) medication adherence, (2) nutrition, (3) physical activity, and (4) sleep.Main Outcome MeasuresPsychological distress, mindfulness, physical activity strategies, nutrition, and exercise self-efficacy.ResultsLinear regression models revealed that those in the PCOS Kind Mind condition reported significantly higher nutrition self-efficacy (β = 6.50, 95% CI, 1.71–11.28, P = 0.013, d = 0.48), physical activity strategies (β = 0.41, 95% CI, 0.04–0.79, P = 0.040, d = 0.67), and physical activity self-efficacy (β = 0.48, 95% CI, 0.07–0.88, P = 0.028, d = 0.46).ConclusionThe PCOS Kind Mind Program improved self-efficacy in the key areas of nutrition and physical activity and increased physical activity strategies in adolescents and young people with PCOS. These findings are encouraging and suggest the need for larger-scale, randomized controlled trials with longer-term follow-up to more robustly evaluate the effects of the PCOS Kind Mind Program on the psychological and physiological health of adolescents and young people with PCOS.     

Scoping Review of the Relationship Between Gestational Diabetes Mellitus and the Neonatal and Infant Gut Microbiome

ObjectiveTo conduct a scoping review to examine the relationship between a diagnosis of gestational diabetes mellitus (GDM) and the neonatal and infant gut microbiome from 0 to 1 year of age.Data SourcesWe searched PubMed, Scopus, Embase, and CINAHL for articles with key terms “microbiome” and “gestational diabetes mellitus.”Study SelectionWe included articles published in English in peer-reviewed journals between 2012 and 2021 that were reports of original research studies in which researchers used next-generation sequencing for analysis of the fecal microbiome and collected meconium or transitional stool from neonates and/or infants.Data ExtractionWe identified nine studies with a combined sample size of 1,279 neonates and infants. We extracted data, including title, authors, sample size, study design, methods, findings, significance, and limitations. We extracted and charted confounding variables such as treatment of GDM, body mass index, gestational age at birth, antibiotic use, mode of birth, and feeding method.Data SynthesisGestational diabetes mellitus may alter the neonatal and infant gut microbiome because neonates and infants of women with GDM had altered composition and diversity compared to neonates and infants of women without GDM.ConclusionMechanisms by which the neonatal and infant microbiome changes in response to GDM are poorly understood and need to be evaluated in future research. Further study of how GDM plays a role in the initial seeding of the microbiome, how the maternal microbiome may affect fetal metabolic programming, and how the neonatal microbiome leads to the future development of obesity and glucose intolerance is critical. Future studies should include larger sample sizes, appropriate collection of potential confounding variables, assessment of maternal interventions for GDM, and longitudinal designs to further understand potential associations with long-term detrimental outcomes such as obesity and impaired glucose tolerance.