Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997-2011.

糖尿病妇女妊娠中的特异性出生缺陷: 国家出生缺陷预防研究,1997-2011。

  • 影响因子:4.22
  • DOI:10.1016/j.ajog.2019.08.028
  • 作者列表:"Tinker SC","Gilboa SM","Moore CA","Waller DK","Simeone RM","Kim SY","Jamieson DJ","Botto LD","Reefhuis J","National Birth Defects Prevention Study.
  • 发表时间:2020-02-01

BACKGROUND:Diabetes is associated with an increased risk for many birth defects and is likely to have an increasing impact on birth defect prevalence because of the rise in diabetes in the United States in recent decades. One of the first analyses in which specific birth defects were assessed for their relationship with both pregestational and gestational diabetes used data from the initial 6 years of the National Birth Defects Prevention Study. That analysis reported strong associations for pregestational diabetes with several birth defects, but few exposures among some of the less common birth defects led to unstable estimates with wide confidence intervals. Since that analysis, the study continued to collect data for another 8 years, including information on approximately 19,000 additional cases and 6900 additional controls. OBJECTIVE:Our objective was to use data from the National Birth Defects Prevention Study, the largest population-based birth defects case-control study in the United States, to provide updated and more precise estimates of the association between diabetes and birth defects, including some defects not previously assessed. STUDY DESIGN:We analyzed data on deliveries from October 1997 through December 2011. Mothers of case and control infants were interviewed about their health conditions and exposures during pregnancy, including diagnosis of pregestational (type 1 or type 2) diabetes before the index pregnancy or gestational diabetes during the index pregnancy. Using logistic regression, we separately assessed the association between pregestational and gestational diabetes with specific categories of structural birth defects for which there were at least 3 exposed case infants. For birth defect categories for which there were at least 5 exposed case infants, we calculated odds ratios adjusted for maternal body mass index, age, education, race/ethnicity, and study site; for defect categories with 3 or 4 exposed cases, we calculated crude odds ratios. RESULTS:Pregestational diabetes was reported by 0.6% of mothers of control infants (71 of 11,447) and 2.5% of mothers of case infants (775 of 31,007). Gestational diabetes during the index pregnancy was reported by 4.7% of mothers of control infants (536 of 11,447) and 5.3% of mothers of case infants (1,653 of 31,007). Pregestational diabetes was associated with strong, statistically significant odds ratios (range, 2.5-80.2) for 46 of 50 birth defects considered. The largest odds ratio was observed for sacral agenesis (adjusted odds ratio, 80.2; 95% confidence interval, 46.1-139.3). A greater than 10-fold increased risk was also observed for holoprosencephaly (adjusted odds ratio, 13.1; 95% confidence interval, 7.0-24.5), longitudinal limb deficiency (adjusted odds ratio, 10.1; 95% confidence interval, 6.2-16.5), heterotaxy (adjusted odds ratio, 12.3; 95% confidence interval, 7.3-20.5), truncus arteriosus (adjusted odds ratio, 14.9; 95% confidence interval, 7.6-29.3), atrioventricular septal defect (adjusted odds ratio, 10.5; 95% confidence interval, 6.2-17.9), and single ventricle complex (adjusted odds ratio, 14.7; 95% confidence interval, 8.9-24.3). For gestational diabetes, statistically significant odds ratios were fewer (12 of 56) and of smaller magnitude (range, 1.3- 2.1; 0.5 for gastroschisis). CONCLUSION:Pregestational diabetes is associated with a markedly increased risk for many specific births defects. Because glycemic control before pregnancy is associated with a reduced risk for birth defects, ongoing quality care for persons with diabetes is an important opportunity for prevention.


背景: 糖尿病与许多出生缺陷的风险增加相关,并且由于近几十年来美国糖尿病的增加,可能对出生缺陷患病率产生越来越大的影响。其中第一个分析中,评估了特定出生缺陷与孕前和妊娠糖尿病的关系,使用了国家出生缺陷预防研究最初 6 年的数据。该分析报告了孕前糖尿病与几种出生缺陷的强相关性,但在一些不太常见的出生缺陷中很少暴露导致估计值不稳定,置信区间较宽。自该分析以来,该研究继续收集数据 8 年,包括大约 19,000 例额外病例和 6900 例额外对照的信息。 目的: 我们的目的是使用来自全国出生缺陷预防研究的数据,这是美国最大的基于人群的出生缺陷病例对照研究,提供更新和更精确的估计糖尿病和出生缺陷之间的关联,包括一些以前没有评估的缺陷。 研究设计: 我们分析了 1997 年 10 月至 2011 年 12 月的分娩数据。对病例和对照婴儿的母亲进行了孕期健康状况和暴露情况的访谈,包括孕前诊断 (1 型或 2 型) 指数妊娠前糖尿病或指数妊娠期间妊娠糖尿病。使用logistic回归,我们分别评估了孕前和妊娠期糖尿病与至少有 3 个暴露病例婴儿的特定类别结构性出生缺陷之间的相关性。对于至少有 5 个暴露病例婴儿的出生缺陷类别,我们计算了校正母亲体重指数、年龄、教育程度、种族/族裔和研究地点的优势比; 对于 3 或 4 个暴露病例的缺陷类别,我们计算了粗略的比值比。 结果: 0.6% 的对照婴儿母亲 (11,447 例中的 71 例) 和 2.5% 的病例婴儿母亲 (775 例中的 31,007 例) 报告了孕前糖尿病。4.7% 的对照婴儿母亲 (536,11,447) 和 5.3% 的病例婴儿母亲 (1,653,31,007) 报告了指数妊娠期间的妊娠期糖尿病。对于 50 例考虑的出生缺陷中的 46 例,妊娠前糖尿病与强、有统计学意义的优势比 (范围,2.5-80.2) 相关。观察到骶骨发育不全的最大比值比 (校正比值比,80.2; 95% 置信区间,46.1-139.3)。还观察到前脑无裂畸形 (校正比值比,13.1; 95% 置信区间,7.0-24.5) 、纵向肢体缺陷 (校正比值比,10.1; 95% 置信区间,6.2-16.5),异源 (校正比值比,12.3; 95% 置信区间,7.3-20.5),动脉干(校正比值比,14.9; 95% 置信区间,7.6-29.3),房室隔缺损 (校正比值比,10.5; 95% 置信区间,6.2-17.9),和单心室复合体 (校正比值比,14.7; 95% 置信区间,8.9-24.3)。对于妊娠糖尿病,统计学上显著的优势比较少 (56 例中的 12 例),幅度较小 (范围,1.3- 2.1; 腹裂为 0.5)。 结论: 孕前糖尿病与许多特定出生缺陷的风险显著增加相关。由于孕前血糖控制与出生缺陷风险降低相关,对糖尿病患者的持续优质护理是预防的重要机会。



作者列表:["Peyroux E","Babinet MN","Cannarsa C","Madelaine C","Favre E","Demily C","Michael GA"]

METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.

作者列表:["Sheridan GA","Nagle M","Howells C","Gallagher O","Kiely PJ","O'Toole P","Kelly PM","Moore DP"]

METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.

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作者列表:["Grigoryan G","Korcek L","Eidelman M","Paley D","Nelson S"]

METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.

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翻译标题与摘要 下载文献