Abstract
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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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.
Armitage P. and Berry J. (1987): Statistical methods in medical research. Blackwell, ed. Oxford, England.
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.
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.
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.
Day R.E. and Insley J. (1976): Maternal diabetes mellitus and congenital malformation: survey of 205 cases - Arch. Dis. Child. 51: 935–938.
Gabbe S. G. (1977): Congenital malformations in infants of diabetic mothers - Obstet. Gynecol. Surv. 32: 125–132.
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.
Goldman J. (1974): Glucose tolerance in mothers of offspring with congenital malformations - Isr. J. Med. Sci. 10: 1434–1437.
Kucera J. (1971): Rate and type of congenital anomalies among offspring of diabetic mothers - J. Reprod. Med. 7: 61–70.
Martinez-Frias M.L. and Salvador J. (1987): Manual Operacional del Estudio Colaborativo Español de Malformaciones Congénitas. M.L. Martinez-Frias, ed. Madrid.
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.
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.
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.
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.
Molsted-Pederson L., Tygstrup I. and Pederson J. (1964): Congenital malformations in newborn infants of diabetic women - Lancet, 1: 1124–1126.
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.
Rowland T.W., Hubell J.P. and Nadas A.S. (1973): Congenital heart disease in infants of diabetic mothers - J. Pediatr. 83: 815–820.
Second International Workshop-Conference on Gestational Diabetes (1985): Summary and recommendations of the second conference on gestational diabetes mellitus - Diabetes 34 (2): 123–126.
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.
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.
Varo R. and Cortina P. (1968): Encuesta sobre prevalencia de diabetes - Rev. San. Hig. Pub. 42: 653–665.
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Ramos-Arroyo, M.A., Rodriguez-Pinilla, E. & Cordero, J.F. Maternal diabetes: The risk for specific birth defects. Eur J Epidemiol 8, 503–508 (1992). https://doi.org/10.1007/BF00146367
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DOI: https://doi.org/10.1007/BF00146367