Effects of Diabetes Can Go Beyond Mom

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Summary and Comment

Effects of Diabetes Can Go Beyond Mom

Pregestational diabetes was associated with a wider range of birth defects than was gestational diabetes.

Maternal diabetes is a risk factor for birth defects, although information about specific anomalies is lacking. In a U.S., population-based, case-control study, researchers used data from the National Birth Defects Prevention Study to evaluate the association of both pregestational diabetes mellitus (PGDM; types 1 and 2) and gestational diabetes mellitus (GDM) with the occurrence of 39 different birth defects. The study population comprised 13,030 cases (stillbirths, terminations, or infants with one or more eligible birth defects) and 4895 controls (infants without birth defects). Diagnoses of maternal PGDM and GDM were self-reported.

The prevalence of PGDM among mothers was 0.5% in the control population (24 of 4895) and 2.2% in the case population (283 of 13,030). The prevalence of GDM was 3.7% in the control population (182 of 4895) and 5.1% in the case population (660 of 13,030). Overall, more than half the women were white. Compared with mothers in the control population, those in the case population were more likely to be obese, to smoke, to have less education and lower incomes, and to have histories of fetal loss and family histories of birth defects. About half the birth-defect categories that were analyzed were attributable to PGDM. The association was stronger for multiple versus isolated birth defects in offspring of women with PGDM (adjusted odds ratios, 8.6 vs. 3.2). Associations between GDM and birth defects were less pronounced (AORs, 1.5 and 1.4 for multiple and isolated defects, respectively) and were limited primarily to women with prepregnancy BMIs $≥$ 25 kg/m².

Comment: These results constitute an important reason why we should pay more heed to diabetes in relation to childbearing. In women with PGDM, better glycemic control before conception could help curtail risk for birth defects among their offspring. Women with PGDM who do not want to conceive (as well as those with suboptimal glycemic control who do want to conceive) should be counseled about appropriate contraception options (JW Womens Health Jan 31 2008). Special attention should be focused on overweight and obese women with GDM, as they might warrant fetal screening for cardiac and noncardiac birth defects. Such women also require surveillance, not only for recurrent GDM in subsequent pregnancies but also for the development of type 2 diabetes later in life.

— Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Published in Journal Watch Women's Health September 18, 2008