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Risk of birth defects associated with maternal pregestational diabetes

  • PERINATAL EPIDEMIOLOGY
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Abstract

Maternal diabetes preceding pregnancy may increase the risk of birth defects in the offspring, but not all studies confirm this association, which has shown considerable variation over time, and the effect of having type 1 versus type 2 diabetes is unclear. We conducted a population-based cohort study in the Northern Italy Emilia-Romagna region linking administrative databases with a Birth Defects Registry. From hospital discharge records we identified all diabetic pregnancies during 1997–2010, and a population of non-diabetic parturients matched for age, residence, year and delivery hospital. We collected available information on education, smoking and drug prescriptions, from which we inferred the type of diabetes. We found 62 malformed infants out of 2,269 births among diabetic women, and 162 out of 10,648 births among non-diabetic women. The age-standardized prevalence ratio (PR) of malformation associated with maternal pregestational diabetes was 1.79 (95 % confidence interval 1.34–2.39), a value that varied little by age. Type of diabetes strongly influenced the PR, with higher values related to type 2 diabetic women. Most major subgroups of anomalies had PRs above 1, including cardiovascular, genitourinary, musculoskeletal, and chromosomal abnormalities. There was an unusually high PR for the rare defect ‘extra-ribs’, but it was based on only two cases. This study indicates that maternal pregestational type 2 diabetes is associated with a higher prevalence of specific birth defects in offspring, whereas for type 1 diabetic mothers, particularly in recent years, the association was unremarkable.

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Acknowledgments

We acknowledge the help of Drs. Eleonora Verdini (Emilia Romagna Regional Health Authority), Paola Ballotari and Paolo Giorgi Rossi (Local Health Unit of Reggio Emilia) and Gianfranco De Girolamo (Local Health Unit of Modena) for their cooperation in retrieving hospital discharge records and performing their linkage with the Reggio Emilia and Modena Diabetes Registries. Financial support to this study was provided by the Local Health Unit of Reggio Emilia and by the Pietro Manodori Foundation of Reggio Emilia.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. CREAGEN - Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Reggio Emilia, Italy

    Marco Vinceti & Carlotta Malagoli

  2. RTI Health Solutions, Research Triangle Park, NC, USA

    Kenneth J. Rothman

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Kenneth J. Rothman

  4. Local Health Unit of Reggio Emilia, Reggio Emilia, Italy

    Rossella Rodolfi, Luisa Paterlini & Fausto Nicolini

  5. IMER Registry, Ferrara University Hospital, Ferrara, Italy

    Gianni Astolfi & Elisa Calzolari

  6. Drug Policy Service, Emilia Romagna Regional Health Authority, Bologna, Italy

    Aurora Puccini

  7. Department of Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena and Reggio Emilia, Modena, Italy

    Marco Bertolotti

  8. Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK

    Mark Lunt

  9. Local Health Unit of Modena, Modena, Italy

    Mariella Martini

  10. CREAGEN - Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università di Modena e Reggio Emilia, Via Campi, 287 - 41125, Modena, Italy

    Marco Vinceti

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  1. Marco Vinceti
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  2. Carlotta Malagoli
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Vinceti, M., Malagoli, C., Rothman, K.J. et al. Risk of birth defects associated with maternal pregestational diabetes. Eur J Epidemiol 29, 411–418 (2014). https://doi.org/10.1007/s10654-014-9913-4

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