Risk of specific congenital abnormalities in offspring of women with diabetes

Nielsen, Gunnar Lauge; Nørgård, Bente Mertz; Puhó, Erzsébet; Rothman, Kenneth J.; Sørensen, Henrik Toft; Czeizel, Andr̀ew E.

doi:10.1111/j.1464-5491.2005.01477.x

Cited by 112 publications

(81 citation statements)

References 26 publications

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“…By appropriate treatment of conditions like diabetes mellitus and infectious diseases of genital organs, embryopathies, preterm births and abortions could be prevented. [5,6] In our study, iron, folicacid, calcium and vitamins were the most frequently used drugs in pregnancy, with an average of 1.73 to 2.89 drugs per pregnant women. Phenobarbitone, isoxsuprine, progesterone, paracetamol, NSAIDs, antibiotics, anti-emetics, proton pump inhibitors/H2 blockers, antacids and antihypertensive drugs (nifedipine, methyldopa) were the other commonly used drugs.…”

Section: Discussionmentioning

confidence: 99%

Drug utilization pattern during pregnancy in North India

Sharma¹,

Kapoor²,

Verma³

2006

Indian J Med Sci

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BACKGROUND: Pregnancy is a special physiological condition, where drug treatment presents a special concern. AIMS: To evaluate the drug utilization pattern during pregnancy and to evaluate the effect of the educational and economic status on it.. DESIGN: The retrospective cross-sectional study. SETTING: The postgraduate Department of Pharmacology and Therapeutics of a medical college. and the antenatal clinic of the institution. MATERIALS AND METHODS: Medical students filled 405 questionnaires after interviewing pregnant women (243 primigravida and 152 multigravida). All the collected questionnaires were analysed for various study parameters. STATISTICAL ANALYSIS USED: Inter-group comparison was done using chi-square test. P value <0.05 was considered statistically significant. RESULTS: A total of 700, 1086 and 686 drugs, with an average of 1.73, 2.89 and 2.49 drugs per pregnant women, were used during first, second and third trimester of pregnancy, respectively. A majority of the drugs used, were from category-A, followed by category-B and category-D. However, category C and X drugs constituted 2.90 (20) and 5.71% (40) of drugs used during the third trimester and first trimester, respectively. Herbal/ homeopathic drugs constituted 6.42 (45), 3.68 (40) and 1.46% (10) of the drugs used in the first, second and third trimester of pregnancy, respectively (P=649). 33.33% (135) women believed that drug use during pregnancy is dangerous to both mother and child and 37.03% (150) believed that drugs are dangerous throughout pregnancy. 55.55% (225) females advocated the use of iron/folic acid during pregnancy. 24.69% (100) of women had knowledge about barrier contraceptives. Self-medication and homeopathic/ herbal drugs use was found more in graduates than in undergraduates; as well as, it was more in the higher socioeconomic group than the lower socioeconomic group. CONCLUSION: There is a need to educate and counsel women of child-bearing age, regarding the advantages and disadvantages of drug use during pregnancies, with special reference to alternative therapies and self-medication.

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Section: Discussionmentioning

confidence: 99%

Drug utilization pattern during pregnancy in North India

Sharma¹,

Kapoor²,

Verma³

2006

Indian J Med Sci

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“…Maternal diabetes has been associated with CHDs [24] and a clear link is shown between glycemic control during organogenesis and congenital malformations [26]. A number of studies have demonstrated a positive association between maternal obesity and CHDs as well [36,38], although others reported contradictory results.…”

Section: Introductionmentioning

confidence: 99%

Maternal intake of fat, riboflavin and nicotinamide and the risk of having offspring with congenital heart defects

et al. 2008

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j Abstract Background With the exception of studies on folic acid, little evidence is available concerning other nutrients in the pathogenesis of congenital heart defects (CHDs). Fatty acids play a central role in embryonic development, and the B-vitamins riboflavin and nicotinamide are co-enzymes in lipid metabolism. Aim of the study To investigate associations between the maternal dietary intake of fats, riboflavin and nicotinamide, and CHD risk in the offspring. Methods A casecontrol family study was conducted in 276 mothers of a child with a CHD comprising of 190 outflow tract defects (OTD) and 86 non-outflow tract defects (non-OTD) and 324 control mothers of a non-malformed child. Mothers filled out general and food frequency questionnaires at 16 months after the index-pregnancy, as a proxy of the habitual food intake in the preconception period. Nutrient intakes (medians)were compared between cases and controls by Mann-Whitney U test. Odds ratios (OR) for the association between CHDs and nutrient intakes were estimated in a logistic regression model. Results Case mothers, in particular mothers of a child with OTD, had higher dietary intakes of saturated fat, 30.9 vs. 29.8 g/d; P < 0.05. Dietary intakes of riboflavin and nicotinamide were lower in mothers of a child with an OTD than in controls (1.32 vs. 1.41 mg/d; P < 0.05 and 14.6 vs. 15.1 mg/d; P < 0.05, respectively). Energy, unsaturated fat, cholesterol and folate intakes were comparable between the groups. Low dietary intakes of both riboflavin (<1.20 mg/d) and nicotinamide (<13.5 mg/d) increased more than two-fold the risk of a child with an OTD, especially in mothers who did not use vitamin supplements in the periconceptional period (OR 2.4, 95%CI 1.4-4.0). Increasing intakes of nicotinamide (OR 0.8, 95%CI 0.7-1.001, per unit standard deviation increase) decreased CHD risk independent of dietary folate intake. Conclusions A maternal diet high in saturated fats and low

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“…3,4 Of those congenital malformations that are seen in offspring of pregestational maternal diabetes, renal malformations such as renal agenesis and congenital abnormalities of kidney and urinary tract are most prevalent. 5 Renal morphogenesis involves complex events in which many genes interact to coordinate the formation of the final kidney. Abnormalities occur when the normal pattern of nephrogenesis is interrupted.…”

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confidence: 99%

Reactive Oxygen Species in the Presence of High Glucose Alter Ureteric Bud Morphogenesis

Zhang

Chen

Tran

et al. 2007

Journal of the American Society of Nephrology

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Renal malformations are a major cause of childhood renal failure. During the development of the kidney, ureteric bud (UB) branching morphogenesis is critical for normal nephrogenesis. These studies investigated whether renal UB branching morphogenesis is altered by a high ambient glucose environment and studied underlying mechanism(s). Kidney explants that were isolated from different periods of gestation (embryonic days 12 to 18) from Hoxb7-green fluorescence protein mice were cultured for 24 h in either normal D-glucose (5 mM) or high D-glucose (25 mM) medium with or without various inhibitors. Alterations in renal morphogenesis were assessed by fluorescence microscopy. Paired-homeobox 2 (Pax-2) gene expression was determined by real-time quantitative PCR, Western blotting, and immunohistology. The results revealed that high D-glucose (25 mM) specifically stimulates UB branching morphogenesis via Pax-2 gene expression, whereas other glucose analogs, such as D-mannitol, L-glucose, and 2-deoxy-Dglucose, had no effect. The stimulatory effect of high glucose on UB branching was blocked in the presence of catalase and inhibitors of NADPH oxidase, mitochondrial electron transport chain complex I, and Akt signaling. Moreover, in in vivo studies, it seems that high glucose induces, via Pax-2 (mainly localized in UB), acceleration of UB branching but not nephron formation. Taken together, these data demonstrate that high glucose alters UB branching morphogenesis. This occurs, at least in part, via reactive oxygen species generation, activation of Akt signaling, and upregulation of Pax-2 gene expression.

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Risk of specific congenital abnormalities in offspring of women with diabetes

Cited by 112 publications

References 26 publications

Drug utilization pattern during pregnancy in North India

Drug utilization pattern during pregnancy in North India

Maternal intake of fat, riboflavin and nicotinamide and the risk of having offspring with congenital heart defects

Reactive Oxygen Species in the Presence of High Glucose Alter Ureteric Bud Morphogenesis

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