Knowledge, attitudes and behaviors related to sexuality and family planning in adolescent women with and without diabetes

BACKGROUND: Sexually active adolescents with diabetes are at high risk for unplanned pregnancies and reproductive complications. OBJECTIVE: Knowledge, attitudes, intentions, and behaviors regarding diabetes and reproductive issues, sexuality, and contraception were examined in teens with diabetes in relation to a non-diabetic group. METHODS: A multisite, case-control, theory-based structured telephone interview was conducted on adolescent women: 80 with diabetes mellitus (DM) and 37 matched controls without diabetes (non-DM). RESULTS: Teens with diabetes appeared to lack an understanding of critical information that could prevent unplanned pregnancies and pregnancy-related complications. Although they scored significantly higher than the non-DM group on diabetes-related information, the DM group had their lowest mean average of 59% for the diabetes and pregnancy score. They did not appear to have greater protective attitudes regarding reproductive health issues than the non-DM group. The DM group felt that they were only moderately susceptible to becoming pregnant and that severe complications would not happen to them. The DM group perceived greater severity to sex-related outcomes (p = 0.001). The DM group did not report safer and more effective family planning behaviors (mean age coitus = 15.7 yr), which for them could be more detrimental. Similar trends were noted between groups regarding contraceptive methods; only a single method (e.g., pill only) rather than a dual method (e.g., pill and condom) was most frequently used. CONCLUSION: Having diabetes did not appear to significantly decrease the risk-taking behavior of the teens. Early and some unsafe sexual practices may increase their risk for an unplanned pregnancy that could result in pregnancy-related complications. Enhancing awareness, knowledge, and attitudes through preconception counseling and reproductive health education may reduce these risks by empowering young women to plan healthy future pregnancies.     

Teenage pregnancy in type 1 diabetes mellitus

Carmody D, Doyle A, Firth RGR, Byrne MM, Daly S, Mc Auliffe F, Foley M, Coulter‐Smith S, Kinsley BT. Teenage pregnancy in type 1 diabetes mellitus Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995–2007. TG booked to the combined diabetes‐obstetrical service at a median gestational age of 11 weeks (range 6–22) compared to 7 weeks in CON (range 4–40, p < 0.02). Glycaemic was worse in TG compared to CON at 13, 26 and 35 weeks gestation, despite higher insulin doses. First trimester miscarriage rate did not differ between groups. Major congenital anomaly rate was 6.2% (1/16) compared to 3.2% in CON. This preliminary study has demonstrated that pregnant teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high‐risk group for adverse pregnancy outcomes.     

Reproductive health beliefs and behaviors in teens with diabetes: application of the Expanded Health Belief Model

OBJECTIVE: To identify significant correlates among constructs of the Expanded Health Belief Model (EHBM) with reproductive health behaviors [preventing an unplanned pregnancy and seeking preconception counseling (PC)] and metabolic control in teenaged women with type 1 diabetes. RESEARCH DESIGN AND METHODS: Eighty adolescent women with type 1 diabetes participated in a multisite, exploratory, case-control study. Subjects (only cases, and not controls, were used for the analyses of this paper) had a single, 1-h structured phone interview with a trained, same gender research assistant. Variables of interest were awareness, knowledge, health beliefs, attitudes, intention and behaviors regarding diabetes and reproductive health. RESULTS: Several major constructs of the EHBM were significantly correlated in the expected direction with reproductive health behaviors and metabolic control of adolescents with type 1 diabetes. In particular, perceived susceptibility, barriers, threat, intention, and self-efficacy with birth control (BC) use, and motivational cue (initial awareness of PC) with seeking PC. CONCLUSIONS: Being told by a health care professional to seek out PC is a motivational cue that triggers action. The timing of this message would seem to play an important role in preventing an unplanned pregnancy. Therefore, interventions focusing on changing health beliefs and on increasing awareness may be effective in promoting positive reproductive health behaviors in adolescent females with diabetes.     

Atypical diabetes mellitus: time for a consensus?

A subgroup of diabetic patients presents with features typical of type 1 diabetes, but over months to years has variable insulin requirements and develops features of type 2 diabetes. This subgroup is referred to as atypical diabetes mellitus (ADM). Over a span of 50 yr, reports on disease epidemiology, clinical characteristics, and metabolic/genetic features of the entity now referred to as ADM remain conflicted. This article reviews the available literature on ADM, proposes atypical diabetes mellitus syndrome (ADMS) as an encompassing nomenclature, and recommends expansive criteria for disease definition pending the release of a consensus recommendation by a panel of experts.     

Dead-in-bed syndrome - a diabetes nightmare

We report in this study the death in bed of a 14-yr-old girl with type 1 diabetes and a review of the existing literature on this topic. Diagnosed at 5 yr of age, the patient followed a relatively benign disease course. Hemoglobin A1c was 6.6-8.4%, and there were no hospital admissions apart from the one at diagnosis. Hypoglycemic episodes were not excessive or severe. At age 14 yr, the patient was found dead in bed after having been well the night before. No apparent explanation could be provided. The 'dead-in-bed' syndrome accounts for 5-6% of mortality cases in patients with type 1 diabetes, amounting to two to six cases per 10 000 patient years. Theories attempting to explain the mechanism for this syndrome include hypoglycemia or cardiac autonomic dysfunction. This case emphasizes several problems faced by clinicians: the risk for sudden death in youth with diabetes, which may compromise good glycemic control, the question of early detection of autonomic dysfunction, and the need to understand this phenomenon better and search for preventive measures.     

Contraception for adolescents with lupus

Sexually active adolescents, including young women with lupus, are at high risk for unplanned pregnancy. Unplanned pregnancy among teens with lupus is associated with an elevated risk of poor maternal and fetal outcomes. The provision of effective contraception is a crucial element of care for a sexually-active young woman with lupus. Unfortunately, providers may be hesitant to prescribe contraception to this group due to concerns about increasing the risk of lupus complications. This article reviews the risks and benefits of currently-available contraceptives for young women with lupus. Providers are encouraged to consider long-term, highly-effective contraception, such as implantables and intrauterine devices, for appropriately selected adolescents with lupus.     

Monogenic diabetes: A single center experience from South India

Monogenic forms of diabetes in children are frequently misclassified as either type 1 diabetes or young‐onset type 2 diabetes. There is a paucity of literature regarding pediatric monogenic diabetes in the Indian population. A retrospective analysis of case records of 37 children with monogenic diabetes who were diagnosed between 2008 and 2019 in a South Indian tertiary care center was performed. The write‐up describes the clinical, biochemical, and genetic characterization of these patients with the diagnoses of neonatal diabetes mellitus (15 patients), MODY (five patients), and various forms of syndromic diabetes (13 with Wolfram syndrome, two with H syndrome, one with mitochondrial diabetes, and one with thiamine responsive megaloblastic anemia).     

Transfer from pediatric to adult health care: effects on diabetes outcomes

The transfer from pediatric to adult diabetes health care for emerging adults with type 1 diabetes (T1D) has received increasing attention in the literature. This review analyzes the effect of this health care transfer on the outcomes of diabetes care visit attendance, glycemic control, and acute diabetes‐related complications, and assesses the methodological strength of the studies reporting observational and interventional data. Observational studies, often limited by incomplete data, report a decline in diabetes care visits but an improvement or no change in hemoglobin A1c (HbA1c) after transfer to adult care. Results from studies reporting a transition intervention are restricted by lack of appropriate control groups and the collection of data both before and after transfer of care. Very few methodologically strong studies are available to guide clinicians with the transition from pediatric to adult care, and these shortcomings should be addressed in future studies designed to facilitate and improve the care of emerging adults with T1D.     

AUTOPSY FINDINGS IN THE WOLCOTT-RALLISON SYNDROME

Wolcott-Rallison syndrome is a rare autosomal recessive condition characterized by diabetes mellitus arising in early infancy and multiple epiphyseal dysplasia. To date, nine cases have been described in the world literature. We report an affected girl who died at the age of 4 years and on whom a full autopsy was performed. In addition to neonatal diabetes mellitus and epiphyseal dysplasia, this child had mental retardation and recurrent episodes of self-limiting hepatic failure. Autopsy revealed severe pancreatic hypoplasia and markedly abnormal pancreatic histology, while histology of the bone was consistent with epiphyseal dysplasia. There was laryngeal stenosis and pulmonary hypoplasia. The heart was enlarged with mitral valve dysplasia and stenosis, left atrial dilatation, left ventricular hypertrophy, and endocardial fibroelastosis. Examination of the central nervous system showed arrhinencephaly and cerebellar cortical dysplasia. The liver showed minor histological abnormalities but no features were present to account for the recurrent hepatic failure. In addition to Wolcott-Rallison syndrome this child had a deletion at 15q11-12 in 65 of her cells.     

Contraceptive choices for females with congenital heart disease

The growing population of adults with congenital heart disease has resulted in the need for focused attention on female reproductive issues. Risk stratification is necessary to evaluate the safety of different contraceptive methods in these complex patients. Comprehensive patient education and counseling should begin in adolescence, focusing on the issues of menstruation, sexual activity, and contraception. Lines of communication should be kept open between the patient and their cardiologist or nurse specialist, so that individual contraceptive needs can be addressed on an ongoing basis. With few exceptions, modern hormonal contraception is safe for women with congenital heart disease, and carries many non-contraceptive benefits. If side effects or thromboembolic risks prohibit this form of contraception, then combined barrier methods, intrauterine devices, or sterilization can provide exceptional protection against pregnancy in properly screened patients.     

Emergency contraception

Teen birth rates in the United States have declined during the last decade but remain much higher than rates in other developed countries. Reduction of unintended pregnancy during adolescence and the associated negative consequences of early pregnancy and early childbearing remain public health concerns. Emergency contraception has the potential to significantly reduce teen-pregnancy rates. This policy statement provides pediatricians with a review of emergency contraception, including a definition of emergency contraception, formulations and potential adverse effects, efficacy and mechanisms of action, typical use, and safety issues, including contraindications. This review includes teens' and young adults' reported knowledge and attitudes about hormonal emergency contraception and issues of access and availability. The American Academy of Pediatrics, as well as other professional organizations, supports over-the-counter availability of emergency contraception. In previous publications, the American Academy of Pediatrics has addressed the issues of adolescent pregnancy and other methods of contraception.     

Comparing three theories in predicting reproductive health behavioral intention in adolescent women with diabetes

BACKGROUND: Understanding factors that affect decision-making in using preconception planning is important to reduce the rate of unplanned pregnancies and pregnancy-related complications in all women with diabetes. Previously, there were no studies of reproductive health-related beliefs, attitudes, or behaviors of adolescent women with diabetes. Constructs from social cognitive models, such as, the health belief model (HBM), theory of reasoned action, and social cognitive theory, are factors that can influence these behavioral outcomes. OBJECTIVE: To compare the predictive powers of these three theories in regard to decision-making with reproductive health behaviors in teens with diabetes and to identify a composite model of the strongest predictors across all three theories. METHOD: Data were collected from a telephone interview by same-gender research assistants on a sample of 87 female adolescents with type 1 diabetes (T1D) from four medical centers using the reproductive health attitudes and behavior (RHAB) questionnaire. Measures represent demographic variables, constructs of the three theories, and behavioral outcomes. Standard multiple regression analyses were used to examine the prediction of the three theories in the outcome variable [intention for using birth control (BC)]. RESULTS: Among the three theories considered, the HBM explained the highest percent of variance (24.4%) in intention to using BC. The best composite model consisted of perceived barriers, cues to action, and self-efficacy (explaining 26.1% of the variance). These three variables were also the strongest predictors among all constructs considered. CONCLUSION: In this sample of adolescent females with T1D, the strongest predictors from the three theories for intention to using BC appeared to be perceived barriers, cues to action, and self-efficacy. Intervention studies to decrease future unplanned pregnancies in this high-risk population could focus on strategies to target these factors that are amenable to change.     

Placental Protein Distribution in Maternal Diabetes Mellitus: An Immunocytochemical Study

Placentas associated with maternal diabetes are generally characterized by features of villous immaturity. We correlated the villous histology with the immunocytochemical distribution of four trophoblastic proteins: beta human chorionic gonadotropin (beta HCG), placental alkaline phosphatase (PLAP), pregnancy specific beta-1-glycoprotein (SP1), and human placental lactogen (HPL) in 14 third-trimester placentas associated with diabetes mellitus. Staining was increased for beta HCG and decreased for PLAP, SP1, and HPL in the diabetic placentas compared to control placentas of similar gestational age. This pattern was most prominent in areas of marked architectural villous immaturity within individual placentas and suggests concomitant functional immaturity.     

Gynecologic health care for the adolescent solid organ transplant recipient

The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. These include attainment of normal growth, involvement in romantic relationships, and the desire to control fertility. As an increasing number of adolescent transplant recipients are involved in normal social and sexual relationships, they require careful attention to their gynecologic and reproductive health care needs. Anticipating the onset of sexual activity before it occurs may help to prevent a mistimed pregnancy by providing or prescribing condoms and emergency contraception in advance. In addition, many transplant recipients can safely use the currently available methods of hormonal contraception provided there is careful attention to organ function, other medical problems, and concurrently prescribed medications. In adolescent patients, issues such as pubertal development and menstruation, contraception, and routine gynecologic health care are typically addressed by the patient's primary care provider. However, the complexity of the adolescent transplant recipient's medical care necessitates close collaboration among all health care providers caring for the patient. This review is intended to help the transplant team better understand the gynecologic health care needs and treatment options of their adolescent patients.     

Does epilepsy occur more frequently in children with Type 1 diabetes?

Aim: Hypoglycaemic seizures are common in children with diabetes and electroencephalogram abnormalities are well recognised in this patient group. Elevated antibodies to glutamic acid decarboxylase, a major auto‐antigen in Type 1 diabetes, are also implicated in a number of neurological disorders. Despite these associations, the question of whether children with diabetes are more prone to epilepsy, possibly as a result of lowered seizure threshold, has not been previously studied. We aimed to determine the prevalence and type of epilepsy in a large paediatric diabetes clinic. Methods: An audit by chart review was carried out at the Diabetes Clinic at the Royal Children's Hospital, Melbourne, Australia. Clinical, demographical, biochemical, EEG and neuro‐imaging data were recorded. Results: Of 1384 children and adolescents aged 0–19 years with Type 1 diabetes, we identified 12 with active epilepsy (prevalence of 8.7/1000), the majority of whom had idiopathic generalised epilepsy and benign focal epilepsy of childhood. These findings are similar to those in the general population. Conclusion: Childhood epilepsy is no more frequently encountered in children and adolescents with Type 1 diabetes than in the general paediatric population.     

Sleep and type 1 diabetes in children and adolescents: Proposed theoretical model and clinical implications

Youth with type 1 diabetes mellitus (T1D) experience more sleep disturbances and shorter sleep durations compared to their healthy peers. Researchers have now uncovered the negative mental health and physical health outcomes associated with poor sleep in youth with T1D. The field of T1D sleep research currently operates under the broad notion that sleep behaviors impact treatment adherence, which ultimately lead to worse long‐term health outcomes. This model however does not explain how behavior influences T1D management and sleep outcomes on a day‐to‐day basis, leading to difficulties in providing tailored treatment recommendations. In this review, we present a theoretical framework that describes the recursive cycle between sleep behaviors, T1D outcomes, and symptoms of negative affect/stress over a 24‐hour period. This model is guided by the sleep literature, showing a clear relationship between poor sleep and negative affect, and the T1D literature demonstrating a link between poor sleep and disease management for youth with T1D. Further, emerging literature indicates a need for additional parent sleep assessment considering that T1D management and fear of hypoglycemia negatively impact parent sleep behaviors. Recommendations are provided to move the field toward effective intervention studies and new areas of research to evaluate and modify the proposed model.     

辅助生殖技术与妊娠期糖尿病孕产妇肠道菌群的特异表达

目的 通过检测和比较不同受孕方式及是否并发妊娠期糖尿病(gestational diabetes mellitus,GDM)孕产妇的肠道菌群,明确辅助生殖技术(assisted reproductive technology,ART)及GDM孕产妇肠道菌群的特异性表达,分析其机制,为今后预防干预、促进ART妊娠母婴健康...