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Glycemic Control in Pregnancies Complicated by Pre-Existing Diabetes Mellitus and Congenital Malformations: A Danish
Linn Håkonsen Arendt1,2,3, Lars Henning Pedersen1,4, Lars Pedersen5
1Department of Obstetrics and Gynecology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Maternal diabetes, including type 1 and type 2, is linked to increased risks of major congenital malformations in infants. Higher glycated haemoglobin (HbA1c) levels during pregnancy correlate with a greater prevalence of these birth defects.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Endocrinology
Background:
- Maternal pre-existing diabetes, specifically type 1 and type 2, poses risks for adverse pregnancy outcomes.
- Congenital malformations represent a significant concern in pregnancies complicated by diabetes.
Purpose of the Study:
- To determine the incidence of major congenital abnormalities in offspring of mothers with type 1 and type 2 diabetes.
- To examine the association between maternal glycated haemoglobin (HbA1c) levels and major congenital malformations, stratified by diabetes type.
Main Methods:
- A register-based study included singletons born in Denmark between 2000-2015.
- Logistic regression models were employed to calculate odds ratios for major congenital malformations based on maternal diabetes status and HbA1c levels.
Main Results:
- Infants born to mothers with type 1 diabetes had a 2.9 times higher odds of major malformations, while those with type 2 diabetes had 1.9 times higher odds.
- The prevalence of major congenital malformations, including cardiac and non-cardiac types, increased with elevated maternal HbA1c levels for both diabetes types.
- No safe threshold for HbA1c was identified; mothers with type 1 diabetes and HbA1c ≥9.5% had an 8.7 times increased odds of major malformations.
Conclusions:
- A progressive increase in major congenital malformations was observed with poorer glycemic control in pregnancies affected by type 1 and type 2 diabetes.
- These findings highlight the critical importance of glycemic control in pregnant women with diabetes to mitigate risks of birth defects.
Purpose:
To study the occurrence of major congenital abnormalities in children of women with type 1 and type 2 diabetes and investigate the association between glycated haemoglobin (HbA1c) and major congenital malformations according to type 1 diabetes and type 2 diabetes separately.
Patients And Methods:
In this register-based study, all singletons born alive from January 1, 2000 to December 31, 2015 in the North Denmark and Central Denmark regions of Denmark and their mothers were included. We used data from Danish health registers and the LABKA database. Logistic regression models were used to compute crude and adjusted prevalence odds ratios (cORs and aORs) with 95% confidence intervals (CIs) for major congenital malformations overall and for subtypes, by type of maternal pre-existing diabetes and HbA1c levels.
Results:
Among 314,245 infants included, 2020 (0.64%) had mothers with type 1 diabetes and 498 (0.16%) had mothers with type 2 diabetes. We found an aOR of 2.9 (95% CI: 2.5, 3.5) and 1.9 (95% CI: 1.3; 2.8) for major malformations for type 1 and type 2 diabetes, respectively. The highest occurrence was seen for major congenital heart diseases, but we also observed higher occurrence of several other non-cardiac malformations. For both type 1 and type 2 diabetes, the prevalence of major congenital malformations increased with higher levels of maternal HbA1c with no safe threshold level. Mothers with type 1 diabetes had higher risks than those without diabetes irrespective of HbA1c, and women with HbA1c levels ≥9.5% had 8 times the odds of major congenital malformations [aOR 8.7 (95% CI: 5.4; 14.5)].
Conclusions:
The prevalence of major congenital malformations progressively increased with poorer glycemic control during pregnancy, with no obvious safe threshold level, for both type 1 and type 2 diabetes.
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