nach oben

Erschienen in:

01.06.2014 | PERINATAL EPIDEMIOLOGY

Risk of birth defects associated with maternal pregestational diabetes

verfasst von: Marco Vinceti, Carlotta Malagoli, Kenneth J. Rothman, Rossella Rodolfi, Gianni Astolfi, Elisa Calzolari, Aurora Puccini, Marco Bertolotti, Mark Lunt, Luisa Paterlini, Mariella Martini, Fausto Nicolini

Erschienen in: European Journal of Epidemiology | Ausgabe 6/2014

Einloggen, um Zugang zu erhalten

Abstract

Maternal diabetes preceding pregnancy may increase the risk of birth defects in the offspring, but not all studies confirm this association, which has shown considerable variation over time, and the effect of having type 1 versus type 2 diabetes is unclear. We conducted a population-based cohort study in the Northern Italy Emilia-Romagna region linking administrative databases with a Birth Defects Registry. From hospital discharge records we identified all diabetic pregnancies during 1997–2010, and a population of non-diabetic parturients matched for age, residence, year and delivery hospital. We collected available information on education, smoking and drug prescriptions, from which we inferred the type of diabetes. We found 62 malformed infants out of 2,269 births among diabetic women, and 162 out of 10,648 births among non-diabetic women. The age-standardized prevalence ratio (PR) of malformation associated with maternal pregestational diabetes was 1.79 (95 % confidence interval 1.34–2.39), a value that varied little by age. Type of diabetes strongly influenced the PR, with higher values related to type 2 diabetic women. Most major subgroups of anomalies had PRs above 1, including cardiovascular, genitourinary, musculoskeletal, and chromosomal abnormalities. There was an unusually high PR for the rare defect ‘extra-ribs’, but it was based on only two cases. This study indicates that maternal pregestational type 2 diabetes is associated with a higher prevalence of specific birth defects in offspring, whereas for type 1 diabetic mothers, particularly in recent years, the association was unremarkable.

Allen VM, Armson BA, Wilson RD, Allen VM, Blight C, Gagnon A, Johnson JA, Langlois S, Summers A, Wyatt P, Farine D, Armson BA, Crane J, Delisle MF, Keenan-Lindsay L, Morin V, Schneider CE, Van Aerde J. Society of O, Gynecologists of C. Teratogenicity associated with pre-existing and gestational diabetes. J Obstet Gynaecol Can. 2007;29:927–44.PubMed

Zabihi S, Loeken MR. Understanding diabetic teratogenesis: where are we now and where are we going? Birth Defects Res A Clin Mol Teratol. 2010;88:779–90.PubMedCrossRef

Kitzmiller JL, Wallerstein R, Correa A, Kwan S. Preconception care for women with diabetes and prevention of major congenital malformations. Birth Defects Res A Clin Mol Teratol. 2010;88:791–803.PubMedCrossRef

Reece EA. Diabetes-induced birth defects: what do we know? What can we do? Curr Diab Rep. 2012;12:24–32.PubMedCrossRef

Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr. 2012;4:41.PubMedCentralPubMedCrossRef

Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986–2000: a population-based cohort study. Birth Defects Res A Clin Mol Teratol. 2005;73:605–11.PubMedCrossRef

Lapolla A, Dalfra MG, Di Cianni G, Bonomo M, Parretti E, Mello G. A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr Metab Cardiovasc Dis. 2008;18:291–7.PubMedCrossRef

Balsells M, Garcia-Patterson A, Gich I, Corcoy R. Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2009;94:4284–91.PubMedCrossRef

Eidem I, Stene LC, Henriksen T, Hanssen KF, Vangen S, Vollset SE, Joner G. Congenital anomalies in newborns of women with type 1 diabetes: nationwide population-based study in Norway, 1999–2004. Acta Obstet Gynecol Scand. 2010;89:1403–11.PubMedCrossRef

10.

Banhidy F, Acs N, Puho EH, Czeizel AE. Congenital abnormalities in the offspring of pregnant women with type 1, type 2 and gestational diabetes mellitus: a population-based case-control study. Congenit Anom (Kyoto). 2010;50:115–21.CrossRef

11.

Beyerlein A, von Kries R, Hummel M, Lack N, Schiessl B, Giani G, Icks A. Improvement in pregnancy-related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during 1987–2007. Diabet Med. 2010;27:1379–84.PubMedCrossRef

12.

Murphy HR, Steel SA, Roland JM, Morris D, Ball V, Campbell PJ, Temple RC. East Anglia study group for improving pregnancy outcomes in women with D. Obstetric and perinatal outcomes in pregnancies complicated by type 1 and type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med. 2011;28:1060–7.PubMedCentralPubMedCrossRef

13.

Bell R, Glinianaia SV, Tennant PW, Bilous RW, Rankin J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia. 2012;55:936–47.CrossRef

14.

Al-Agha R, Firth RG, Byrne M, Murray S, Daly S, Foley M, Smith SC, Kinsley BT. Outcome of pregnancy in type 1 diabetes mellitus (T1DMP): results from combined diabetes-obstetrical clinics in Dublin in three university teaching hospitals (1995–2006). Ir J Med Sci. 2012;181:105–9.PubMedCrossRef

15.

Garne E, Loane M, Dolk H, Barisic I, Addor MC, Arriola L, Bakker M, Calzolari E, Matias Dias C, Doray B, Gatt M, Melve KK, Nelen V, O’Mahony M, Pierini A, Randrianaivo-Ranjatoelina H, Rankin J, Rissmann A, Tucker D, Verellun-Dumoulin C, Wiesel A. Spectrum of congenital anomalies in pregnancies with pregestational diabetes. Birth Defects Res A Clin Mol Teratol. 2012;94:134–40.PubMedCrossRef

16.

Correa A, Gilboa SM, Botto LD, Moore CA, Hobbs CA, Cleves MA, Riehle-Colarusso TJ, Waller DK, Reece EA. Lack of periconceptional vitamins or supplements that contain folic acid and diabetes mellitus-associated birth defects. Am J Obstet Gynecol. 2012;206:218.e1–13.PubMed

17.

Fung A, Manlhiot C, Naik S, Rosenberg H, Smythe J, Lougheed J, Mondal T, Chitayat D, McCrindle BW, Mital S. Impact of prenatal risk factors on congenital heart disease in the current era. J Am Heart Assoc. 2013;2:e000064.PubMedCentralPubMedCrossRef

18.

Liu S, Joseph KS, Lisonkova S, Rouleau J, Van den Hof M, Sauve R, Kramer MS, Canadian Perinatal Surveillance S. Association between maternal chronic conditions and congenital heart defects: a population-based cohort study. Circulation. 2013;128:583–9.PubMedCrossRef

19.

Csaky-Szunyogh M, Vereczkey A, Kosa Z, Gerencser B, Czeizel AE. Risk factors in the origin of congenital left-ventricular outflow-tract obstruction defects of the heart: a population-based case-control study. Pediatr Cardiol. 2014;35:108–20.

20.

Newham JJ, Glinianaia SV, Tennant PW, Rankin J, Bell R. Improved antenatal detection of congenital anomalies in women with pre-gestational diabetes: population-based cohort study. Diabet Med. 2013;30:1442–8.PubMedCrossRef

21.

Feig DS, Hwee J, Shah BR, Booth GL, Bierman AS, Lipscombe LL. Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996–2010. Diabetes Care. 2014. doi:10.2337/dc13-2717.

22.

McCarter RJ, Kessler II, Comstock GW. Is diabetes mellitus a teratogen or a coteratogen? Am J Epidemiol. 1987;125:195–205.PubMed

23.

Moore LL, Singer MR, Bradlee ML, Rothman KJ, Milunsky A. A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus. Epidemiology. 2000;11:689–94.PubMedCrossRef

24.

McCance DR. Pregnancy and diabetes. Best Pract Res Clin Endocrinol Metab. 2011;25:945–58.PubMedCrossRef

25.

Botta RM. Congenital malformations in infants of 517 pregestational diabetic mothers. Ann Ist Super Sanita. 1997;33:307–11.PubMed

26.

Ballotari P, Chiatamone Ranieri S, Vicentini M, Caroli S, Gardini A, Rodolfi R, Crucco R, Greci M, Manicardi V, Giorgi Rossi P. Building a population-based diabetes register: an Italian experience. Diabetes Res Clin Pract. 2014;103:79–87.PubMedCrossRef

27.

Boyd PA, Haeusler M, Barisic I, Loane M, Garne E, Dolk H. Paper 1: the EUROCAT network—organization and processes. Birth Defects Res A Clin Mol Teratol. 2011;91(Suppl 1):S2–15.PubMedCrossRef

28.

Boulot P, Chabbert-Buffet N, d’Ercole C, Floriot M, Fontaine P, Fournier A, Gillet JY, Gin H, Grandperret-Vauthier S, Geudj AM, Guionnet B, Hauguel-de-Mouzon S, Hieronimus S, Hoffet M, Jullien D, Lamotte MF, Lejeune V, Lepercq J, Lorenzi F, Mares P, Miton A, Penfornis A, Pfister B, Renard E, Rodier M, Roth P, Sery GA, Timsit J, Valat AS, Vambergue A, Verier-Mine O, Diabetes, Pregnancy Group F. French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care. 2003;26:2990–3.PubMedCrossRef

29.

Correa A, Gilboa SM, Besser LM, Botto LD, Moore CA, Hobbs CA, Cleves MA, Riehle-Colarusso TJ, Waller DK, Reece EA. Diabetes mellitus and birth defects. Am J Obstet Gynecol. 2008;199:237.e1–9.

30.

Dunne FP, Avalos G, Durkan M, Mitchell Y, Gallacher T, Keenan M, Hogan M, Carmody LA, Gaffney G, collaborators AD. ATLANTIC DIP: pregnancy outcomes for women with type 1 and type 2 diabetes. Ir Med J. 2012;105:6–9.PubMed

31.

McElvy SS, Miodovnik M, Rosenn B, Khoury JC, Siddiqi T, Dignan PS, Tsang RC. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels. J Matern Fetal Med. 2000;9:14–20.PubMed

32.

Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004;328:915.PubMedCentralPubMedCrossRef

33.

Temple RC, Aldridge VJ, Murphy HR. Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care. 2006;29:1744–9.PubMedCrossRef

34.

Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care. 2009;32:2005–9.PubMedCentralPubMedCrossRef

35.

Jensen DM, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard JG, Moeller M, Beck-Nielsen H. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care. 2004;27:2819–23.PubMedCrossRef

36.

Temple R, Murphy H. Type 2 diabetes in pregnancy—an increasing problem. Best Pract Res Clin Endocrinol Metab. 2010;24:591–603.PubMedCrossRef

37.

Cundy T, Gamble G, Townend K, Henley PG, MacPherson P, Roberts AB. Perinatal mortality in type 2 diabetes mellitus. Diabet Med. 2000;17:33–9.PubMedCrossRef

38.

Dunne F, Brydon P, Smith K, Gee H. Pregnancy in women with type 2 diabetes: 12 years outcome data 1990-2002. Diabet Med. 2003;20:734–8.PubMedCrossRef

39.

McElduff A, Ross GP, Lagstrom JA, Champion B, Flack JR, Lau SM, Moses RG, Seneratne S, McLean M, Cheung NW. Pregestational diabetes and pregnancy: an Australian experience. Diabetes Care. 2005;28:1260–1.PubMedCrossRef

40.

Clausen TD, Mathiesen E, Ekbom P, Hellmuth E, Mandrup-Poulsen T, Damm P. Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care. 2005;28:323–8.PubMedCrossRef

41.

Roland JM, Murphy HR, Ball V, Northcote-Wright J, Temple RC. The pregnancies of women with type 2 diabetes: poor outcomes but opportunities for improvement. Diabet Med. 2005;22:1774–7.PubMedCrossRef

42.

Macintosh MC, Fleming KM, Bailey JA, Doyle P, Modder J, Acolet D, Golightly S, Miller A. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006;333:177.PubMedCentralPubMedCrossRef

43.

Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ. Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies. BMC Pregnancy Childbirth. 2006;6:30.PubMedCentralPubMedCrossRef

44.

Lapolla A, Dalfra MG, Fedele D. Pregnancy complicated by type 2 diabetes: an emerging problem. Diabetes Res Clin Pract. 2008;80:2–7.PubMedCrossRef

45.

Murphy HR, Roland JM, Skinner TC, Simmons D, Gurnell E, Morrish NJ, Soo SC, Kelly S, Lim B, Randall J, Thompsett S, Temple RC. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care. 2010;33:2514–20.PubMedCentralPubMedCrossRef

46.

Waller DK, Shaw GM, Rasmussen SA, Hobbs CA, Canfield MA, Siega-Riz AM, Gallaway MS, Correa A, National Birth Defects Prevention S. Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med. 2007;161:745–50.PubMedCrossRef

47.

Dennedy MC, Avalos G, O’Reilly MW, O’Sullivan EP, Gaffney G, Dunne F. ATLANTIC-DIP: raised maternal body mass index (BMI) adversely affects maternal and fetal outcomes in glucose-tolerant women according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. J Clin Endocrinol Metab. 2012;97:E608–12.PubMedCrossRef

48.

Block SR, Watkins SM, Salemi JL, Rutkowski R, Tanner JP, Correia JA, Kirby RS. Maternal pre-pregnancy body mass index and risk of selected birth defects: evidence of a dose-response relationship. Paediatr Perinat Epidemiol. 2013;27:521–31.PubMedCrossRef

49.

Ekpebegh CO, Coetzee EJ, van der Merwe L, Levitt NS. A 10-year retrospective analysis of pregnancy outcome in pregestational type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Diabet Med. 2007;24:253–8.PubMedCrossRef

50.

Martinez-Frias ML. Epidemiological analysis of outcomes of pregnancy in diabetic mothers: identification of the most characteristic and most frequent congenital anomalies. Am J Med Genet. 1994;51:108–13.PubMedCrossRef

51.

Ewart-Toland A, Yankowitz J, Winder A, Imagire R, Cox VA, Aylsworth AS, Golabi M. Oculoauriculovertebral abnormalities in children of diabetic mothers. Am J Med Genet. 2000;90:303–9.PubMedCrossRef

52.

Aberg A, Westbom L, Kallen B. Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Hum Dev. 2001;61:85–95.PubMedCrossRef

53.

Frias JL, Frias JP, Frias PA, Martinez-Frias ML. Infrequently studied congenital anomalies as clues to the diagnosis of maternal diabetes mellitus. Am J Med Genet A. 2007;143A:2904–9.PubMedCrossRef

54.

Lupo PJ, Canfield MA, Chapa C, Lu W, Agopian AJ, Mitchell LE, Shaw GM, Waller DK, Olshan AF, Finnell RH, Zhu H. Diabetes and obesity-related genes and the risk of neural tube defects in the national birth defects prevention study. Am J Epidemiol. 2012;176:1101–9.PubMedCentralPubMedCrossRef

55.

Giampietro PF, Raggio CL, Blank RD, McCarty C, Broeckel U, Pickart MA. Clinical, genetic and environmental factors associated with congenital vertebral malformations. Mol Syndromol. 2013;4:94–105.PubMedCentralPubMed

56.

Chernoff N, Rogers JM. Supernumerary ribs in developmental toxicity bioassays and in human populations: incidence and biological significance. J Toxicol Environ Health B Crit Rev. 2004;7:437–49.PubMedCrossRef

57.

Unger E, Kjellen L, Eriksson UJ. Effect of insulin on the altered production of proteoglycans in rib cartilage of experimentally diabetic rats. Arch Biochem Biophys. 1991;285:205–10.PubMedCrossRef

58.

Unger E, Eriksson UJ. Regionally disturbed production of cartilage proteoglycans in malformed fetuses from diabetic rats. Diabetologia. 1992;35:517–21.PubMedCrossRef

59.

Jiang HJ, Andrews R, Stryer D, Friedman B. Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes. Am J Public Health. 2005;95:1561–7.PubMedCentralPubMedCrossRef

60.

Verheijen EC, Critchley JA, Whitelaw DC, Tuffnell DJ. Outcomes of pregnancies in women with pre-existing type 1 or type 2 diabetes, in an ethnically mixed population. BJOG. 2005;112:1500–3.PubMedCrossRef

61.

Dunne FP, Brydon PA, Proffitt M, Smith T, Gee H, Holder RL. Fetal and maternal outcomes in Indo-Asian compared to Caucasian women with diabetes in pregnancy. QJM. 2000;93:813–8.PubMedCrossRef

62.

Chaudhry T, Ghani AM, Mehrali TH, Taylor RS, Brydon PA, Gee H, Barnett AH, Dunne FP. A comparison of foetal and labour outcomes in Caucasian and Afro-Caribbean women with diabetes in pregnancy. Int J Clin Pract. 2004;58:932–6.PubMedCrossRef

63.

Hughes R, Rowan J. Perinatal outcomes and macrosomia in a multi-ethnic population of women with type 2 diabetes. Aust N Z J Obstet Gynaecol. 2006;46:552–5.PubMedCrossRef

64.

Jonasson JM, Brismar K, Sparen P, Lambe M, Nyren O, Ostenson CG, Ye W. Fertility in women with type 1 diabetes: a population-based cohort study in Sweden. Diabetes Care. 2007;30:2271–6.PubMedCrossRef

65.

Bell R, Bailey K, Cresswell T, Hawthorne G, Critchley J, Lewis-Barned N. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG. 2008;115:445–52.PubMedCrossRef

66.

Guerin A, Nisenbaum R, Ray JG. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes. Diabetes Care. 2007;30:1920–5.PubMedCrossRef

67.

Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ. The role of modifiable pre-pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes. Acta Obstet Gynecol Scand. 2009;88:1153–7.PubMedCrossRef

68.

Parker SE, Yazdy MM, Tinker SC, Mitchell AA, Werler MM. The impact of folic acid intake on the association among diabetes mellitus, obesity, and spina bifida. Am J Obstet Gynecol. 2013;209:239.e1–8.

Titel: Risk of birth defects associated with maternal pregestational diabetes
verfasst von: Marco Vinceti
Carlotta Malagoli
Kenneth J. Rothman
Rossella Rodolfi
Gianni Astolfi
Elisa Calzolari
Aurora Puccini
Marco Bertolotti
Mark Lunt
Luisa Paterlini
Mariella Martini
Fausto Nicolini
Publikationsdatum: 01.06.2014
Verlag: Springer Netherlands
Erschienen in: European Journal of Epidemiology / Ausgabe 6/2014
Print ISSN: 0393-2990
Elektronische ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-014-9913-4

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2014

Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies

The Maastricht Study: an extensive phenotyping study on determinants of type 2 diabetes, its complications and its comorbidities

Adverse outcomes of frailty in the elderly: the Rotterdam Study

Place of upbringing in early childhood as related to inflammatory bowel diseases in adulthood: a population-based cohort study in Northern Europe

Wars versus SARS: Are epidemiological studies biased?

Personalised medicine, disease prevention, and the inverse care law: more harm than benefit?