Risk of birth defects associated with maternal pregestational diabetes
Risk of birth defects associated with maternal pregestational diabetes
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DOI：
10.1007/s10654-014-9913-4
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发表时间：
2014-06-01
影响因子：
13.6
通讯作者：
Nicolini, Fausto
中科院分区：
文献类型：
--
作者：
Vinceti, Marco;Malagoli, Carlotta;Nicolini, Fausto
母亲在怀孕前患糖尿病可能会增加后代出生缺陷的风险，但并非所有研究都证实了这种关联，随着时间的推移，这种关联显示出相当大的变化，并且1型糖尿病与2型糖尿病的影响尚不清楚。我们在北方意大利埃米利亚-罗马涅地区进行了一项基于人群的队列研究，将行政数据库与出生缺陷登记处联系起来。从出院记录中，我们确定了1997-2010年期间所有的糖尿病妊娠，以及年龄、居住地、年份和分娩医院相匹配的非糖尿病产妇。我们收集了关于教育、吸烟和药物处方的可用信息，从中我们推断出糖尿病的类型。我们发现，在糖尿病妇女中，2,269名新生儿中有62名畸形婴儿，在非糖尿病妇女中，10,648名新生儿中有162名畸形婴儿。与母亲妊娠前糖尿病相关的畸形的年龄标准化患病率（PR）为1.79（95%置信区间1.34-2.39），该值随年龄变化不大。糖尿病类型强烈影响PR，与2型糖尿病女性相关的数值较高。大多数主要异常亚组的PR均大于1，包括心血管、泌尿生殖系统、肌肉骨骼和染色体异常。罕见缺陷“额外肋骨”的PR异常高，但仅基于两例病例。这项研究表明，母亲妊娠前2型糖尿病与后代特定出生缺陷的患病率较高有关，而对于1型糖尿病母亲，特别是近年来，这种关联并不明显。
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.