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首页> 外文期刊>Pediatric diabetes. >Outcomes, care utilization, and expenditures in adolescent pregnancy complicated by diabetes
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Outcomes, care utilization, and expenditures in adolescent pregnancy complicated by diabetes

机译：结果，护理利用率和青少年妊娠的支出并复杂化糖尿病

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Abstract Background and Objective Adolescence and pregestational diabetes separately increase risks of adverse pregnancy outcomes, but little is known about their combined effect. To analyze pregnancy outcomes, healthcare utilization, and expenditures in adolescent pregnancies with and without pregestational diabetes using a national claims database. Methods Retrospective study using Truven Health MarketScan Commercial Claims and Encounters Database, 2011 to 2015. Females 12 to 19 years old, continuously enrolled for at least 12 months before a livebirth until 2 months after, were included. Pregestational diabetes, diabetes complications (ketoacidosis, retinopathy, neuropathy, nephropathy), comorbidities, and pregnancy outcomes (preeclampsia, preterm delivery, high birthweight, cesarean delivery) were identified using claims data algorithms. Healthcare utilization and payer expenditure were tabulated per enrollee. Multivariate logistic regressions assessed pregnancy outcomes; multivariate OLS regression assessed payer expenditures. Results About 33?502 adolescents were included. Adolescents without diabetes had pregnancy outcomes consistent with national estimates. Adolescents with uncomplicated diabetes had increased odds of preeclampsia adjusted odds ratios 2.41 (95% confidence interval 1.93‐3.02), preterm delivery 1.50 (1.21‐1.87), high birthweight 1.84 (1.50‐2.27), and cesarean delivery 1.81 (1.52‐2.15). Diabetes with ketoacidosis and/or end‐organ damage had higher odds of preeclampsia 5.62 (2.77‐11.41), preterm delivery 5.81 (3.00‐11.25), high birthweight 2.38 (1.08‐5.24), and cesarean delivery 3.43 (1.78‐6.64). Adolescents with diabetes utilized significantly more outpatient and inpatient care during pregnancy. Payer expenditures increased by 45.3% (34.8‐55.9%) among adolescents with diabetes and by 82.6% (49.1‐116.0%) among adolescents with diabetes complicated by ketoacidosis and/or end‐organ damage. Conclusion Compared with normal adolescent pregnancies, pregestational diabetes significantly increases risks of adverse pregnancy outcomes and significantly escalates healthcare utilization and cost.
机译：摘要背景和客观青春期和普遍糖尿病分别增加了不良妊娠结果的风险，但对它们的综合效果知之甚少。使用国家索赔数据库分析青少年怀孕的妊娠结果，医疗利用率和支出，并不使用普通糖尿病。方法采用Truven Health Marketscan商业索赔和遭遇数据库的回顾性研究，2011年至2015年.2至19岁，持续在腰胎前至少12个月内纳入2个月后，包括在内。使用索赔数据算法确定了促导糖尿病（酮症性，视网膜病，视网膜病，视网膜病变，神经病变，肾病成果（预胰岛素，早产，高等生产，剖腹产）。医疗保健利用率和付款人支出都是针对性的。多变量逻辑回归评估妊娠结果;多元ols回归评估了付款人支出。结果约为33？502个青少年。没有糖尿病的青少年与国家估计符合妊娠结局。具有简单糖尿病的青少年具有预坦克敏调整的差距2.41（95％置信区间1.93-3.02），早产1.50（1.21-1.87），高等生产1.84（1.50-2.27），剖腹产1.81（1.52-2.15） 。具有酮催化和/或末端器官损伤的糖尿病具有较高的预口化5.62（2.77-11.41），早产10.81（3.00-11.25），高等生重量2.38（1.08-5.24），剖腹产3.43（1.78-6.64）。糖尿病的青少年在怀孕期间使用显着的门诊和住院护理。付款人支出在糖尿病患有糖尿病的青少年增加45.3％（34.8-55.9％），糖尿病和/或末端器官损伤的糖尿病复杂82.6％（49.1-116.0％）。结论与正常青少年妊娠相比，普遍糖尿病显着提高了不利妊娠成果的风险，并显着升级了医疗保健利用率和成本。

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