1044-P: Impact of Pregnancy on Microvascular and Cardiac Outcomes in Youth-Onset Type 2 Diabetes

This analysis compared microvascular and cardiac outcomes from women in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, originally diagnosed with youth-onset Type 2 diabetes between the ages of 10-17 yrs, who experienced a pregnancy lasting 20 wks during the course of the study vs. those without. Pregnancy information was obtained prospectively by self-report followed by medical record review. Neuropathy and nephropathy were assessed annually. Retinopathy, echocardiography, and arterial stiffness were assessed twice during the study. Women with a history of pregnancy prior to the initial assessment were excluded. Of the 4women in TODAY, 116 reported a pregnancy lasting ≥ 20 weeks, with 67 having a single pregnancy and 49 with multiple pregnancies. The mean age at first pregnancy was 21.6 yrs. and mean diabetes duration 8 yrs. At study entry, women who reported a pregnancy during the trial were older (14 yrs. vs. 13.6 yrs., p=0.05) with lower household income (51.5% vs. 37.8% below $25,000, p=0.002) . Primary study outcome, defined as HbA1c >8% or inability to wean from insulin, was similar between the two groups. In Cox regression models adjusted for participant characteristics from study entry including age, race/ethnicity, household income, diabetes duration, HbA1c (>6%) , and BMI, women with a pregnancy had an increased risk of hyperfiltration, 2.76 (1.38-5.49) , p=0.0vs. those without a pregnancy. No differences were observed in rates of retinopathy, neuropathy, or macro- and microalbuminuria in women with vs. without a history of pregnancy. In fully adjusted models, history of pregnancy did not impact echocardiographic measures or arterial stiffness obtained prior to the reported pregnancy versus the measures after the pregnancy. These results suggest that pregnancy increases the risk of hyperfiltration in women with youth-onset T2D, but not other micro or macrovascular complications.