Diabetes
Maternal Sociodemographic, Pre-Pregnancy, and Pregnancy Factors Associated with Type 2 Diabetes in Adolescents and Young Adults: The PAPAYA Study Saher Daredia* Saher Daredia Daredia Daredia Daredia Daredia Daredia Daredia Daredia saherdaredia@berkeley.edu
Background: Youth type 2 diabetes (T2D) rates have risen globally. Preconception and pregnancy are sensitive periods for later T2D risk, yet specific exposures contributing to risk remain unclear. We examined associations between maternal and pregnancy factors and early-onset child T2D in the Predictors of Adverse Cardiometabolic Problems in Adolescents and Young Adults (PAPAYA) study at Kaiser Permanente Northern California (KPNC).
Methods: This retrospective cohort included 303,037 racially diverse individuals born at KPNC in 2003-2011. Maternal (education, age, parity, Medicaid coverage, pre-pregnancy BMI and diabetes) and pregnancy (gestational diabetes, preeclampsia, preterm birth, delivery mode) factors were obtained from electronic health records and birth certificates. Early-onset T2D (ages 10–21; N=453) was identified via the KPNC Diabetes Registry. Cox proportional hazards models estimated hazard ratios (HR) adjusting for key confounders.
Results: Lower maternal education was associated with higher hazard of early-onset T2D (HR=2.98; 95% CI: 1.97-4.51 for < high school vs. postgraduate), as were older age at delivery (HR per year=1.04; 95% CI: 1.02-1.06), greater parity (HR per birth=1.11; 95% CI: 1.03-1.20), and Medicaid coverage during pregnancy (HR=2.05; 95% CI: 1.46-2.88). Pre-pregnancy maternal overweight (HR: 2.74; 95% CI: 1.97-3.82) and obesity (HR: 5.46; 95% CI: 3.96-7.53) vs. underweight/normal weight, gestational diabetes (HR: 3.41; 95% CI: 2.48-4.68) and preeclampsia (HR: 1.65; 95% CI: 1.02-2.67) were also associated with higher hazards. Maternal pre-pregnancy diabetes showed time-varying associations, with HRs decreasing from 31.08 (95% CI: 17.85-54.13) at age 10 to 5.99 (95% CI: 2.64-13.56) at age 20. Preterm birth and delivery mode showed no associations.
Conclusion: Several maternal sociodemographic, pre-pregnancy, and pregnancy factors were associated with early-onset T2D, providing potential targets for early-life interventions.
