Is Diabetes Mellitus a Teratogen or a Coteratogen?

McCarter, Robert; Kessler, Irving I.; Comstock, George W.

doi:10.1093/oxfordjournals.aje.a114520

Cited by 27 publications

(7 citation statements)

References 12 publications

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“…In several other studies, researches have reported no increased risk of birth defects among infants born to mothers with gestational diabetes (5,13,21); in only a few studies have results indicated an increased risk (1,4,9). Our study shows that gestational diabetic mothers who required insulin during pregnancy were 1.9 times more likely to have an infant with a major birth defect.…”

Section: Discussionmentioning

confidence: 93%

Maternal diabetes: The risk for specific birth defects

1992

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We studied the risk for specific birth defects among infants of mothers with gestational and chronic diabetes using data collected by the Spanish Collaborative Study of Congenital Malformations (ECEMC). For the years 1976 to 1985, we identified 10,087 infants with malformations and 9,994 control infants; 155 of the case infants and 89 of the controls were born to diabetic mothers. The crude odds ratio for any minor or major defect and insulin-treated diabetes was 5.5 (95% CI = 1.2, 24.8), and for major malformations it was 8.7 (95% CI = 1.8, 34.7). The risk for defects involving the central nervous system (CNS), skeletal system and cardiovascular system were significantly increased. Infants of non-insulin-treated diabetic mothers were 2.9 times more likely to have a major congenital birth defect (95% CI = 1.2, 7.2). The crude odds ratio for any major or minor defect and mothers with gestational diabetes requiring insulin was 1.9 (95% CI = 1.1, 3.4). Similar risk was observed for major defects (OR = 1.9, 95% CI = 1.0, 3.7). These results suggest that infants of insulin-treated diabetic mothers have an increased risk of developing malformations of the CNS, cardiovascular system and skeletal system. We also found an increased risk for specific defect categories among infants of mothers with gestational diabetes treated with insulin.

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Section: Discussionmentioning

confidence: 93%

Maternal diabetes: The risk for specific birth defects

1992

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“…If the risk was a classic multifactoral trait, one would expect to see it symmetrically distributed from both mothers and fathers. More directly, McCarter et al 21 have shown no increased risk for major malformations in pregnancies of women that were conceived prior to the development of diabetes mellitus.…”

Section: Summary Of the Relationship Between Control And First-trimesmentioning

confidence: 98%

Spontaneous Abortions and Major Malformations in Women with Diabetes Mellitus

Greene¹

1999

Semin Reprod Med

115

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Women with insulin dependent diabetes mellitus are at increased risk for both first trimester spontaneous abortions and major congenital malformations when they become pregnant. The magnitudes of both of these risks depend upon the degree of metabolic control of their diabetes in the first trimester. The risks differ in the degree of control necessary to minimize them and the degree to which they can ultimately be reduced. A stricter degree of metabolic control is necessary to avoid spontaneous abortions than major malformations. Although the risks for both complications can be reduced by improved metabolic control, the risk for major malformations remains elevated, when compared to the risk for non-diabetic women, despite good to excellent control. In contrast, good to excellent control does reduce the risk for spontaneous abortions to a rate comparable to that seen in non-diabetic women. Women with insulin dependent diabetes mellitus who are planning pregnancies should be encouraged to achieve the best possible degree of metabolic control prior to and throughout pregnancy. They should be re-assured, however, that perfect control is not necessary to avoid dramatically increased risks for spontaneous abortions and major malformations.

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“…It is well accepted that maternal diabetes is a major risk factor for CVMs and other serious birth defects [Mills, 1982;McCarter et al, 1987;Becerra et al, 1990;Ferencz et al, 1990;RamosArroyo et al, 1992] and that the greatest vulnerability is in early pregnancy [Mills et al, 1979;Reece et al, 1996]. These observations focus attention…”

Section: Maternal Risk Factorsmentioning

confidence: 99%

Epidemiology of cardiovascular malformations: Prevalence and risk factors

Loffredo

2000

Am. J. Med. Genet.

162

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Epidemiological approaches to the study of cardiovascular malformations (CVMs) face challenges of disease definition, nomenclature, changing diagnostic methodologies, the rarity of the disease in the general population, and the incorporation of current knowledge on genetics and morphogenesis into designing studies to investigate risk factors and implement preventive strategies. Previous studies, especially the population-based Baltimore-Washington Infant Study, have documented variability in the prevalence of specific types of CVM by time, place, and personal characteristics and have highlighted the potential prevention of diabetes-associated heart malformations through timely medical management of pre-conception diabetes. Left-sided obstructive heart defects have been identified as targets for new studies of genetic risk factors. Potential environmental risk factors for CVMs also have been identified, such as organic solvents and pesticides, coincident with the emergence of new strategies to study genetic susceptibility and gene-environment interactions. Increased collaborative, multicenter research on these and other factors, such as nutritional factors in early pregnancy, offers new hope for potentially reducing the burden of CVM in the population.

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Is Diabetes Mellitus a Teratogen or a Coteratogen?

Cited by 27 publications

References 12 publications

Maternal diabetes: The risk for specific birth defects

Maternal diabetes: The risk for specific birth defects

Spontaneous Abortions and Major Malformations in Women with Diabetes Mellitus

Epidemiology of cardiovascular malformations: Prevalence and risk factors

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