European Journal of Epidemiology

, Volume 8, Issue 4, pp 503–508 | Cite as

Maternal diabetes: The risk for specific birth defects

  • M. A. Ramos-Arroyo
  • E. Rodriguez-Pinilla
  • J. F. Cordero


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.

Key words

Abnormality Birth defect Maternal diabetes mellitus Pregnancy 


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  1. 1.
    Amanhwah K.S., Kaufman R., Roller R. W., Dawson-Saunders B. and Prentice R.L. (1981): Incidence of congenital abnormalities in infants of gestational diabetic mothers - J. Perinatol. Med. 9: 223–227.Google Scholar
  2. 2.
    Armitage P. and Berry J. (1987): Statistical methods in medical research. Blackwell, ed. Oxford, England.Google Scholar
  3. 3.
    Ballard J.L., Holroyde J., Tsang R.C. et al., (1984): High malformation rates and decreased mortality in infants of diabetic mothers after the first trimester of pregnancy (1956–1978) - Am. J. Obstet. Gynecol. 148 (8): 1111–1118.Google Scholar
  4. 4.
    Becerra J.E., Khoury M.J., Cordero J.F. and Erickson J.D. (1990): Diabetes mellitus during pregnancy and the risk for specific birth defects: a population-based case-control study - Pediatrics 85 (1): 1–9.Google Scholar
  5. 5.
    Chung C.S. and Myrianthopoulos N.C. (1975): Factors affecting risks of congenital malformations. In: BergsmaD., ed. Birth defects: Original articles series, XI, (10, II). Miami: Symposia Specialists for The National Foundation-March of Dimes, 23–37.Google Scholar
  6. 6.
    Day R.E. and Insley J. (1976): Maternal diabetes mellitus and congenital malformation: survey of 205 cases - Arch. Dis. Child. 51: 935–938.Google Scholar
  7. 7.
    Gabbe S. G. (1977): Congenital malformations in infants of diabetic mothers - Obstet. Gynecol. Surv. 32: 125–132.Google Scholar
  8. 8.
    Gabbe S. G., Mestman J.H., Freeman R.K. et al., (1977): Management and outcome of pregnancy in diabetes mellitus, Classes B to R - Am. J. Obstet. Gynecol. 129 (7): 723–731.Google Scholar
  9. 9.
    Goldman J. (1974): Glucose tolerance in mothers of offspring with congenital malformations - Isr. J. Med. Sci. 10: 1434–1437.Google Scholar
  10. 10.
    Kucera J. (1971): Rate and type of congenital anomalies among offspring of diabetic mothers - J. Reprod. Med. 7: 61–70.Google Scholar
  11. 11.
    Martinez-Frias M.L. and Salvador J. (1987): Manual Operacional del Estudio Colaborativo Español de Malformaciones Congénitas. M.L. Martinez-Frias, ed. Madrid.Google Scholar
  12. 12.
    Martinez-Frias M.L., Ramos-Arroyo M.A. and Salvador J. (1988): Thanatophoric dysplasia: A new dominant mutation? Am. J. Med. Genet. 31: 815–820.Google Scholar
  13. 13.
    McCarter R.J., Kessler I.I. and Comstock G. W. (1987): Is diabetes mellitus a teratogen or a coteratogen? Am. J. Epidemiol. 125 (2): 195–205.Google Scholar
  14. 14.
    Mills J.L., Knopp R.H., Simpson J.L. et al., (1988): Lack of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis - N. Eng. J. Med. 318 (11): 671–676.Google Scholar
  15. 15.
    Milunsky A., Alpert E., Kitzmiller J.L., Younger M.D. and Neff R.K. (1982): Prenatal diagnosis of neural tube defects. VIII. The importance of serum alphafetoprotein screening in diabetic pregnant women - Am. J. Obstet. Gynecol. 142 (8):1030–1032.Google Scholar
  16. 16.
    Molsted-Pederson L., Tygstrup I. and Pederson J. (1964): Congenital malformations in newborn infants of diabetic women - Lancet, 1: 1124–1126.Google Scholar
  17. 17.
    Pallardo Sanchez L.F., Ferre C., Puertas L. and Pallardo Peinado L.F. (1980): Prevalencia de la morbilidad diabética conocida en la población rural española en 1978 - Rev. Clin. Esp. 159(4): 243–249.Google Scholar
  18. 18.
    Rowland T.W., Hubell J.P. and Nadas A.S. (1973): Congenital heart disease in infants of diabetic mothers - J. Pediatr. 83: 815–820.Google Scholar
  19. 19.
    Second International Workshop-Conference on Gestational Diabetes (1985): Summary and recommendations of the second conference on gestational diabetes mellitus - Diabetes 34 (2): 123–126.Google Scholar
  20. 20.
    Simpson J.L., Sherman E., Martin A.0. et al., (1983): Diabetes in pregnancy. Northwestern University Series (1977–1981). 1. Prospective study of anomalies in offspring of mothers with diabetes mellitus - Am. J. Obstet. Gynecol. 146 (3): 263–270.Google Scholar
  21. 21.
    Soler N.G., Walsh C.H. and Malins J.M. (1976): Congenital malformations in newborn infants of diabetic mothers. Q. J. Med. 45 (178): 303–313.Google Scholar
  22. 22.
    Varo R. and Cortina P. (1968): Encuesta sobre prevalencia de diabetes - Rev. San. Hig. Pub. 42: 653–665.Google Scholar

Copyright information

© Gustav Fischer 1992

Authors and Affiliations

  • M. A. Ramos-Arroyo
    • 1
  • E. Rodriguez-Pinilla
    • 2
  • J. F. Cordero
    • 3
  1. 1.Servicio de GeneticaHospital Virgen del CaminoNavarraSpain
  2. 2.Estudio Collborativo Español de Maformaciones Congénitas (ECEMC)Hospital Universitario San Carlos - Facultad de Medicina - Universidad ComplutenseMadridSpain
  3. 3.Birth Defects and Genetic Diseases Branch - Division of the Birth Defects and Developmental Disabilities - Center for Environmental Health and Injury Control - Centers for Disease Control Public Health ServiceU.S. Department of Health and Human ServicesAtlantaUSA

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