Improved antenatal detection of congenital anomalies in women with pre‐gestational diabetes: population‐based cohort study

Newham, James; Glinianaia, Svetlana V.; Tennant, Pwg; Rankin, Judith; Bell, Ruth

doi:10.1111/dme.12293

Cited by 9 publications

(13 citation statements)

References 22 publications

(36 reference statements)

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“…However, we did not observe any difference in the TGA cohort in which terminations were few. Pregestational diabetes leads to more thorough follow up and a higher prenatal detection rate of congenital anomalies . We did not observe a significant difference in prenatal detection of UVH and TGA among mothers with pregestational diabetes; the numbers were, however, limited.…”

Section: Discussioncontrasting

confidence: 74%

“…Pregestational diabetes leads to more thorough follow up and a higher prenatal detection rate of congenital anomalies. 35 We did not observe a significant difference in prenatal detection of UVH and TGA among mothers with pregestational diabetes; the numbers were, however, limited. In agreement with previous studies, 36 CHD was associated with multiple pregnancies.…”

Section: Discussioncontrasting

confidence: 57%

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The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects: an 11‐year national population‐based cohort study

Hautala

Gissler

Ritvanen

et al. 2019

BJOG

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Objective To evaluate whether a nationwide prenatal anomaly screening programme improves detection rates of univentricular heart (UVH) and transposition of great arteries (TGA), and whether maternal risk factors for severe fetal heart disease affect prenatal detection. Design Population‐based cohort study. Setting Nationwide data from Finnish registries 2004–14. Population A total of 642 456 parturients and 3449 terminated pregnancies due to severe fetal anomaly. Methods Prenatal detection rates were calculated in three time periods (prescreening, transition and screening phase). The effect of maternal risk factors (obesity, in vitro fertilisation, pregestational diabetes and smoking) was evaluated. Main outcome measures Change in detection rates and impact of maternal risk factors on screening programme efficacy. Results In total, 483 cases of UVH and 184 of TGA were detected. The prenatal detection rate of UVH increased from 50.4% to 82.8% and of TGA from 12.3% to 41.0% (P < 0.0001). Maternal risk factors did not affect prenatal detection rate, but detection rate differed substantially by region. Conclusions A nationwide screening programme improved overall UVH and TGA detection rates, but regional differences were observed. Obesity or other maternal risk factors did not affect the screening programme efficacy. The establishment of structured guidelines and recommendations is essential when implementing the screening programme. In addition, a prospective screening register is highly recommended to ensure high quality of screening. Tweetable abstract Implementation of a nationwide prenatal anomaly screening improved detection rates of UVH and TGA.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussioncontrasting

confidence: 57%

The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects: an 11‐year national population‐based cohort study

Hautala

Gissler

Ritvanen

et al. 2019

BJOG

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“…The rate of congenital anomalies, which was 27.5% in our cohort, is considerable. It is high in comparison with other cohorts of women with pre‐existing diabetes in pregnancy, but lower than other groups which have reported rates as high as 50% . For example, Eriksen and colleagues conducted a systematic review and found that the prevalence of congenital malformations was 6.4% in women with Type 1 diabetes .…”

Section: Discussioncontrasting

confidence: 66%

“…For example, Eriksen and colleagues conducted a systematic review and found that the prevalence of congenital malformations was 6.4% in women with Type 1 diabetes [4]. By contrast, Newham and colleagues reported a prevalence rate of congenital malformations of 50.3% in the offspring of women with pre-existing diabetes [15]. The explanation for this is multifactorial.…”

Section: Discussionmentioning

confidence: 99%

The association between vascular complications during pregnancy in women with Type 1 diabetes and congenital malformations

et al. 2018

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Aims To assess the association between vascular complications of diabetes and the risk of congenital malformations in pregnant women with Type 1 diabetes. Methods We conducted an observational retrospective cohort study in women with Type 1 diabetes who received care consecutively from three tertiary care diabetes‐in‐pregnancy clinics in Calgary, Alberta, Canada. Multivariable logistic regression was used to assess the association between vascular complications (retinopathy, nephropathy and pre‐existing hypertension) and congenital malformations in offspring of women with Type 1 diabetes. Results Of 232 women with Type 1 diabetes, 49 (21%) had at least one vascular complication and there were 52 babies with congenital malformations. Maternal age (31.8 ± 5.0 vs. 29.4 ± 4.7 years, P < 0.01), diabetes duration (20.9 ± 6.7 vs. 11.2 ± 7.4 years, P < 0.01) and pre‐eclampsia rate (12.5% vs. 1.3%, P < 0.01) were higher in mothers with vascular complications than in those without. Multivariable analyses showed that vascular complications were not associated with an increased risk of congenital malformations (odds ratio 1.16, 95% confidence interval 0.46 to 2.88). Conclusions Vascular complications are common, occurring in one‐fifth of pregnant women with Type 1 diabetes, and in this study do not appear to be associated with an increased risk of congenital malformations in children.

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“…Thus, we cannot exclude that we have missed diagnoses of fetal malformations in terminated pregnancies. Male sex has recently been identified as the only factor associated with a higher antenatal detection rate of congenital malformations . Against this background, we cannot exclude that the rate of abortions attributable to congenital anomalies is higher in pregnancies with male fetuses, leading to an underestimation of the risk for malformations.…”

Section: Discussionmentioning

confidence: 89%

Perinatal outcome in relation to fetal sex in offspring to mothers with pre‐gestational and gestational diabetes—a population‐based study

Persson

Fadl

2014

Diabet. Med.

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The risk of adverse perinatal outcome in offspring of mothers with Type 1 diabetes and gestational diabetes did not differ by sex, except for a higher risk in male infants for respiratory disorders. The risk of major malformations was also significantly increased in male offspring to mothers with gestational diabetes. In offspring of mothers with Type 2 diabetes, no significant differences between sexes were found.

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Improved antenatal detection of congenital anomalies in women with pre‐gestational diabetes: population‐based cohort study

Abstract: Antenatal detection of cardiovascular anomalies was higher in women with diabetes, suggesting that recommendations for enhanced cardiovascular scanning may improve detection. Greater awareness of the increased risk of anomalies in other organ systems is needed.

Cited by 9 publications

References 22 publications

The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects: an 11‐year national population‐based cohort study

The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects: an 11‐year national population‐based cohort study

The association between vascular complications during pregnancy in women with Type 1 diabetes and congenital malformations

Perinatal outcome in relation to fetal sex in offspring to mothers with pre‐gestational and gestational diabetes—a population‐based study

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