Original Findings and Updated Meta-Analysis for the Association Between Maternal Diabetes and Risk for Congenital Heart Disease Phenotypes

Abstract

Maternal diabetes is associated with congenital heart defects (CHDs) as a group, but few studies have assessed risk for specific CHD phenotypes. We analyzed these relationships using data from the Texas Birth Defects Registry and statewide vital records for deliveries taking place in 1999-2009 (n = 48,249 cases). We used Poisson regression to calculate prevalence ratios for the associations between maternal diabetes (pregestational or gestational) and each CHD phenotype, adjusting for potential confounders. Analyses were repeated by type of diabetes. To address the potential for misclassification bias, we performed logistic regression, using malformed controls. We also conducted meta-analyses, combining our estimates of the association between pregestational diabetes and each CHD phenotype with previous estimates. The prevalence of every CHD phenotype was greater among women with pregestational diabetes than among nondiabetic women. Most of these differences were statistically significant (adjusted prevalence ratios = 2.47-13.20). Associations were slightly attenuated for many CHD phenotypes among women with gestational diabetes. The observed associations did not appear to be the result of misclassification bias. In our meta-analysis, pregestational diabetes was significantly associated with each CHD phenotype. These findings contribute to a better understanding of the teratogenic effects of maternal diabetes and improved counseling for risk of specific CHD phenotypes.

Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes

“…Congenital malformations are one of the principal contributors to the high perinatal mortality observed in pregnancies complicated with pregestational diabetes [7,8,70,71]. Maternal hyperglycemia at the time of organogenesis is the main teratogen [72,73].…”

Cardiac function in newborns of obese women and the effect of exercise during pregnancy. A randomized controlled trial

“…Maternal obesity has been shown to increase the risk of congenital heart defects [ 9 , 10 , 38 ], as is also the case for maternal diabetes [ 39 , 40 ]. In our study, we only detected minor cardiac defects, 8/55 (15%) in the NOW group and 2/20 (10%) in the NNW group.…”

Environmental Risk Factors for Congenital Heart Disease

“…Gestational diabetes is a transient disease similar to type II that develops during pregnancy, but resolves following parturition. Offspring of mothers with preexisting diabetes (types I and II) have an approximately threefold increased risk of any type of CHD (Hoang et al 2017), and gestational diabetes carries an approximately 1.5-fold increased CHD risk (Hoang et al 2017). This is also the case when the data is adjusted for potential confounders such as maternal body mass index, alcohol use, and age.…”

“…In addition, these children have elevated risks for other developmental abnormalities such spina bifida, anencephaly, craniofacial anomalies, and macrosomia. When broken down into specific subtypes, it is clear that some of these carry a particularly increased risk, for example, the risk of PTA is increased 14-fold (Hoang et al 2017). The mechanism by which maternal diabetes increases CHD risk is far from clear (Basu and Garg 2018).…”