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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
Abstract

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.

摘要

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。

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