1
|
Chiu YH, Huybrechts KF, Patorno E, Yland JJ, Cesta CE, Bateman BT, Seely EW, Hernán MA, Hernández-Díaz S. Metformin Use in the First Trimester of Pregnancy and Risk for Nonlive Birth and Congenital Malformations: Emulating a Target Trial Using Real-World Data. Ann Intern Med 2024; 177:862-870. [PMID: 38885505 DOI: 10.7326/m23-2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Metformin is a first-line pharmacotherapy for type 2 diabetes, but there is limited evidence about its safety in early pregnancy. OBJECTIVE To evaluate the teratogenicity of metformin use in the first trimester of pregnancy. DESIGN In an observational cohort of pregnant women with pregestational type 2 diabetes receiving metformin monotherapy before the last menstrual period (LMP), a target trial with 2 treatment strategies was emulated: insulin monotherapy (discontinue metformin treatment and initiate insulin within 90 days of LMP) or insulin plus metformin (continue metformin and initiate insulin within 90 days of LMP). SETTING U.S. Medicaid health care administration database (2000 to 2018). PARTICIPANTS 12 489 pregnant women who met the eligibility criteria. MEASUREMENTS The risk and risk ratio of nonlive births, live births with congenital malformations, and congenital malformations among live births were estimated using standardization to adjust for covariates. RESULTS A total of 850 women were in the insulin monotherapy group and 1557 in the insulin plus metformin group. The estimated risk for nonlive birth was 32.7% under insulin monotherapy (reference) and 34.3% under insulin plus metformin (risk ratio, 1.02 [95% CI, 1.01 to 1.04]). The estimated risk for live birth with congenital malformations was 8.0% (CI, 5.7% to 10.2%) under insulin monotherapy and 5.7% (CI, 4.5% to 7.3%) under insulin plus metformin (risk ratio, 0.72 [CI, 0.51 to 1.09]). LIMITATION Possible residual confounding by glycemic control and body mass index. CONCLUSION Compared with switching to insulin monotherapy, continuing metformin and adding insulin in early pregnancy resulted in little to no increased risk for nonlive birth among women receiving metformin before pregnancy. Under conventional statistical criteria, anything between a 49% decrease and a 9% increase in risk for congenital malformations was highly compatible with our data. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Yu-Han Chiu
- CAUSALab and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Y.-H.C., S.H.)
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (K.F.H., E.P.)
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (K.F.H., E.P.)
| | - Jennifer J Yland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts (J.J.Y.)
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (C.E.C.)
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (B.T.B.)
| | - Ellen W Seely
- Endocrinology, Diabetes and Hypertension Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (E.W.S.)
| | - Miguel A Hernán
- CAUSALab, Department of Epidemiology, and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (M.A.H.)
| | - Sonia Hernández-Díaz
- CAUSALab and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Y.-H.C., S.H.)
| |
Collapse
|
2
|
Agaoglu Z, Tanacan A, Ipek G, Peker A, Ozturk Agaoglu M, Bastemur AG, Kara O, Sahin D. Utility of the cerebro-placental-uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:745-752. [PMID: 38655708 DOI: 10.1002/jcu.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To examine the cerebro-placental-uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes. METHODS This prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low-risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated. RESULTS CPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut-off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut-off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity). CONCLUSION Low CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.
Collapse
Affiliation(s)
- Zahid Agaoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Goksun Ipek
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayca Peker
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Merve Ozturk Agaoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayse Gulcin Bastemur
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
3
|
Koefoed AS, Knorr S, Fuglsang J, Leth-Møller M, Hulman A, Jensen DM, Andersen LLT, Rosbach AE, Damm P, Mathiesen ER, Sørensen A, Christensen TT, McIntyre HD, Ovesen P, Kampmann U. Hemoglobin A1c Trajectories During Pregnancy and Adverse Outcomes in Women With Type 2 Diabetes: A Danish National Population-Based Cohort Study. Diabetes Care 2024; 47:1211-1219. [PMID: 38771955 DOI: 10.2337/dc23-2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/19/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To identify and characterize groups of pregnant women with type 2 diabetes with distinct hemoglobin A1c (HbA1c) trajectories across gestation and to examine the association with adverse obstetric and perinatal outcomes. RESEARCH DESIGN AND METHODS This was a retrospective Danish national cohort study including all singleton pregnancies in women with type 2 diabetes, giving birth to a liveborn infant, between 2004 and 2019. HbA1c trajectories were identified using latent class linear mixed-model analysis. Associations with adverse outcomes were examined with logistic regression models. RESULTS A total of 1,129 pregnancies were included. Three HbA1c trajectory groups were identified and named according to the glycemic control in early pregnancy (good, 59%; moderate, 32%; and poor, 9%). According to the model, all groups attained an estimated HbA1c <6.5% (48 mmol/mol) during pregnancy, with no differences between groups in the 3rd trimester. Women with poor glycemic control in early pregnancy had lower odds of having an infant with large-for-gestational-age (LGA) birth weight (adjusted odds ratio [aOR] 0.57, 95% CI 0.40-0.83), and higher odds of having an infant with small-for-gestational age (SGA) birth weight (aOR 2.49, 95% CI 2.00-3.10) and congenital malformation (CM) (aOR 4.60 95% CI 3.39-6.26) compared with women with good glycemic control. There was no evidence of a difference in odds of preeclampsia, preterm birth, and caesarean section between groups. CONCLUSIONS Women with poor glycemic control in early pregnancy have lower odds of having an infant with LGA birth weight, but higher odds of having an infant with SGA birth weight and CM.
Collapse
Affiliation(s)
- Anna S Koefoed
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Magnus Leth-Møller
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Lise Lotte T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - A Emilie Rosbach
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Trine T Christensen
- Steno Diabetes Center Aalborg, Aalborg University Hospital, Aalborg, Denmark
| | - H David McIntyre
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Per Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Koyama M, Taki M, Okamoto H, Kawamura Y, Ueda Y, Chigusa Y, Mandai M, Mogami H. Characteristics of pregnancy complicated with type 1 and type 2 diabetes. Taiwan J Obstet Gynecol 2023; 62:655-660. [PMID: 37678991 DOI: 10.1016/j.tjog.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Diabetes in pregnancy is a major risk factor for adverse perinatal outcomes such as congenital anomalies, hypertensive disorders of pregnancy (HDP), and macrosomia. For the mechanism of onset of type 1 and type 2 diabetes are different, we focused on the difference in perinatal outcomes between the type 1 and type 2 diabetes groups. MATERIALS AND METHODS We retrospectively reviewed 22 pregnancies with type 1 diabetes and 15 pregnancies with type 2 diabetes, who were managed in our single center, with regard to maternal diabetes conditions during pregnancy and neonatal birthweight and blood glucose level. Furthermore, we checked the effect of continuous glucose monitoring and continuous subcutaneous insulin injection in pregnancies with type 1 diabetes. RESULTS Type 1 diabetes in pregnancy was less controllable and increased neonatal birth weight and neonatal hypoglycemia within 2 h after birth after neonatal care unit admission. Continuous glucose monitoring and continuous subcutaneous insulin injection that are convenient to use, had a similar effect in the management of type 1 diabetes during pregnancy, compared with conventional diabetes treatment. In contrast, maternal BMI and HDP were increased in women with type 2 diabetes. CONCLUSION In the management of pregnancy with diabetes, we should pay attention to the difference in pregnancy prognosis between type 1 and type 2 diabetes.
Collapse
Affiliation(s)
- Misaki Koyama
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Haruko Okamoto
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
5
|
Peng Z, Wei J, Chen B, Huang X, Song P, Liang L, He J, Feng B, Que T, Qin J, Xie Y, Qiu X, Wei H, He S. Epidemiology of birth defects based on a birth defects surveillance system in southwestern China and the associated risk factors. Front Pediatr 2023; 11:1165477. [PMID: 37547102 PMCID: PMC10401059 DOI: 10.3389/fped.2023.1165477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Birth defects (BDs) are associated with many potential risk factors, and its causes are complex. Objectives This study aimed to explore the epidemiological characteristics of BDs in Guangxi of China and the associated risk factors of BDs. Methods BDs data of perinatal infants (PIs) were obtained from the Guangxi birth defects monitoring network between 2016 and 2020. Univariate Poisson regression was used to calculate the prevalence-rate ratios (PRR) to explore the changing trends of BDs prevalence by year and the correlation between the regarding of characteristics of BDs (including infant gender, maternal age, and quarter) and BDs. Clinical characteristics of PIs with BDs and general characteristics of their mothers were documented, and Spearman correlation analysis was used to explore the potential associated risk factors of BDs. Results Between 2016 and 2020, 44,146 PIs with BDs were monitored, with an overall BDs prevalence of 121.71 (95% CI: 120.58-122.84) per 10,000 PIs, showing a significant increase trend (PRR = 1.116, 95% CI: 1.108-1.123), especially the prevalence of congenital heart defects (CHDs) that most significantly increased (PRR = 1.300, 95% CI: 1.283-1.318). The 10 most common BDs were CHDs, polydactyly, congenital talipes equinovarus, other malformation of external ear, syndactyly, hypospadias, cleft lip with cleft palate, cleft lip, hemoglobin Bart's hydrops fetalis syndrome (BHFS), and congenital atresia of the rectum and anus. BDs were positively correlated with pregnant women's age (R = 0.732, P < 0.01) and education level (R = 0.586, P < 0.05) and having pre-gestational diabetes mellitus (PGDM)/gestational diabetes mellitus (GDM) (R = 0.711, P < 0.01), while when the pregnant women had a family history of a dead fetus (R = -0.536, P < 0.05) and a birth of a fetus with BDs (R = -0.528, P < 0.05) were negatively correlated with BDs. Conclusion A significant increase in the prevalence of BDs was detected between 2016 and 2020 in Guangxi, especially the prevalence of CHDs that most significantly increased. Older maternal age, higher maternal education level, and having PGDM before pregnancy or GDM in early pregnancy were the risk factors for BDs.
Collapse
Affiliation(s)
- Zhenren Peng
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Jie Wei
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Biyan Chen
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Xiuning Huang
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Pengshu Song
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Lifang Liang
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Jiajia He
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Baoying Feng
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Ting Que
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Jie Qin
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Yu'an Xie
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Xiaoxia Qiu
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Hongwei Wei
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| | - Sheng He
- Birth Defects Research Laboratory, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning, China
- Birth Defects Research Laboratory, Birth Defects Prevention and Control Institute of Guangxi Zhuang Autonomous Region, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Reproductive Health and Birth Defect Prevention, Nanning, China
- Birth Defects Research Laboratory, Guangxi Key Laboratory of Birth Defects Research and Prevention, Nanning, China
| |
Collapse
|
6
|
Marchincin SL, Howley MM, Van Zutphen AR, Fisher SC, Nestoridi E, Tinker SC, Browne ML. Risk of birth defects by pregestational type 1 or type 2 diabetes: National Birth Defects Prevention Study, 1997-2011. Birth Defects Res 2023; 115:56-66. [PMID: 35665489 PMCID: PMC10582790 DOI: 10.1002/bdr2.2050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previous studies found consistent associations between pregestational diabetes and birth defects. Given the different biological mechanisms for type 1 (PGD1) and type 2 (PGD2) diabetes, we used National Birth Defects Prevention Study (NBDPS) data to estimate associations by diabetes type. METHODS The NBDPS was a study of major birth defects that included pregnancies with estimated delivery dates from October 1997 to December 2011. We compared self-reported PGD1 and PGD2 for 29,024 birth defect cases and 10,898 live-born controls. For case groups with ≥5 exposed cases, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between specific defects and each diabetes type. We calculated crude ORs (cORs) and 95% CIs with Firth's penalized likelihood for case groups with 3-4 exposed cases. RESULTS Overall, 252 (0.9%) cases and 24 (0.2%) control mothers reported PGD1, and 357 (1.2%) cases and 34 (0.3%) control mothers reported PGD2. PGD1 was associated with 22/26 defects examined and PGD2 was associated with 29/39 defects examined. Adjusted ORs ranged from 1.6 to 70.4 for PGD1 and from 1.6 to 59.9 for PGD2. We observed the strongest aORs for sacral agenesis (PGD1: 70.4, 32.3-147; PGD2: 59.9, 25.4-135). For both PGD1 and PGD2, we observed elevated aORs in every body system we evaluated, including central nervous system, orofacial, eye, genitourinary, gastrointestinal, musculoskeletal, and cardiac defects. CONCLUSIONS We observed positive associations between both PGD1 and PGD2 and birth defects across multiple body systems. Future studies should focus on the role of glycemic control in birth defect risk to inform prevention efforts.
Collapse
Affiliation(s)
| | - Meredith M. Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Alissa R. Van Zutphen
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
| | - Sarah C. Fisher
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Eirini Nestoridi
- Massachusetts Center for Birth Defects Research and Prevention, Boston, Massachusetts, USA
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marilyn L. Browne
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
| | | |
Collapse
|
7
|
Newman C, Egan AM, Ahern T, Al-Kiyumi M, Bacon S, Bahaeldein E, Balan G, Brassill MJ, Breslin E, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Elhilo K, Cullen E, Fenlon M, Ferry P, Gabir A, Guinan L, Hanlon G, Heffernan M, Higgins T, Hoashi S, Kgosidialwa O, Khamis A, Kinsley B, Kirwan B, James A, Kyithar P, Liew A, Malik I, Matthews L, McGurk C, McHugh C, Moloney Y, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor A, O'Connor E, O'Halloran D, O'Mahoney L, O'Shea T, O'Sullivan EP, Peters M, Roberts G, Rooney H, Sharma J, Smyth A, Synnott M, Tarachand B, Tighe M, Todd M, Towers M, Tuthill A, Mahmood W, Yousif O, Dunne FP. Retrospective national cohort study of pregnancy outcomes for women with type 1 and type 2 diabetes mellitus in Republic of Ireland. Diabetes Res Clin Pract 2022; 189:109947. [PMID: 35709911 DOI: 10.1016/j.diabres.2022.109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/14/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
AIM Report the outcomes of pregnant women with type 1 and type 2 diabetes and to identify modifiable and non-modifiable factors associated with poor outcomes. METHODS Retrospective analysis of pregnancy preparedness, pregnancy care and outcomes in the Republic of Ireland from 2015 to 2020 and subsequent multivariate analysis. RESULTS In total 1104 pregnancies were included. Less than one third attended pre-pregnancy care (PPC), mean first trimester haemoglobin A1c was 7.2 ± 3.6% (55.5 ± 15.7 mmol/mol) and 52% received pre-conceptual folic acid. Poor preparation translated into poorer pregnancy outcomes. Livebirth rates (80%) were comparable to the background population however stillbirth rates were 8.7/1000 (four times the national rate). Congenital anomalies occurred in 42.5/1000 births (1.5 times the background rate). More than half of infants were large for gestational age and 47% were admitted to critical care. Multivariate analyses showed strong associations between non-attendance at PPC, poor glycaemic control and critical care admission (adjusted odds ratio of 1.68 (1.48-1.96) and 1.61 (1.43-1.86), p < 0.05 respectively) for women with type 1 diabetes. Smoking and teratogenic medications were also associated with critical care admission and hypertensive disorders of pregnancy. CONCLUSION Pregnancy outcomes in women with diabetes are suboptimal. Significant effort is needed to optimize the modifiable factors identified in this study.
Collapse
Affiliation(s)
| | - Aoife M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States of America
| | - Tomas Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Republic of Ireland
| | - Maisa Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Siobhan Bacon
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | | | - Gabriela Balan
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Mary-Jane Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Republic of Ireland
| | - Emily Breslin
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | | | | | - Hilda Clarke
- Portiuncula University Hospital, Co Galway, Republic of Ireland
| | | | - Linda Culliney
- Cork University Hospital, Cork, Co Cork, Republic of Ireland
| | - Recie Davern
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Maeve Durkan
- Bon Secours Hospital, Cork, Co Cork, Republic of Ireland
| | - Kalthoom Elhilo
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Elizabeth Cullen
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Mairead Fenlon
- Wexford General Hospital, Co Wexford, Republic of Ireland
| | - Pauline Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland
| | - Ahmed Gabir
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | - Linda Guinan
- South Tipperary General Hospital, Clonmel, Co Tipperary, Republic of Ireland
| | - Geraldine Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Republic of Ireland
| | - Marie Heffernan
- South Infirmary Victoria University Hospital, Cork, Co Cork, Republic of Ireland
| | - Tom Higgins
- University Hospital Kerry, Tralee, Co Kerry, Republic of Ireland
| | - Shu Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Republic of Ireland
| | | | - Amjed Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland
| | - Brendan Kinsley
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Breda Kirwan
- Galway University Hospital, Galway, Republic of Ireland
| | - Anne James
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Republic of Ireland
| | - Pyeh Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Aaron Liew
- Portiuncula University Hospital, Co Galway, Republic of Ireland
| | | | - Linda Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Republic of Ireland
| | - Colm McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Republic of Ireland
| | - Cathy McHugh
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | - Yvonne Moloney
- University of Limerick UL Hospitals Group, Co Limerick, Republic of Ireland
| | - Matt S Murphy
- South Infirmary Victoria University Hospital, Cork, Co Cork, Republic of Ireland
| | - Paula Murphy
- Cork University Hospital, Cork, Co Cork, Republic of Ireland
| | - Dina Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Eoin Noctor
- University of Limerick UL Hospitals Group, Co Limerick, Republic of Ireland
| | - Marie Nolan
- University Hospital Kerry, Tralee, Co Kerry, Republic of Ireland
| | - Aislong O'Connor
- Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland
| | - Emily O'Connor
- Portiuncula University Hospital, Co Galway, Republic of Ireland
| | | | - Linda O'Mahoney
- Cork University Hospital, Cork, Co Cork, Republic of Ireland
| | - Triona O'Shea
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | | | - Moby Peters
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | - Graham Roberts
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | - Hannorah Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Republic of Ireland
| | - Jayant Sharma
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | - Aoife Smyth
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Maria Synnott
- Portlaoise General Hospital, Portlaoise, Co Laois, Republic of Ireland
| | | | - Marie Tighe
- Sligo University Hospital, Co Sligo, Republic of Ireland
| | - Marie Todd
- Mayo University Hospital, Co Mayo, Republic of Ireland
| | - Michael Towers
- University Hospital Waterford, Co Waterford, Republic of Ireland
| | | | - Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Republic of Ireland
| | - Obada Yousif
- Wexford General Hospital, Co Wexford, Republic of Ireland
| | | |
Collapse
|
8
|
Chelu S, Bernad E, Craina M, Neamtu R, Mocanu AG, Vernic C, Chiriac VD, Tomescu L, Borza C. Prevalence of Gestational Diabetes in preCOVID-19 and COVID-19 Years and Its Impact on Pregnancy: A 5-Year Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12051241. [PMID: 35626396 PMCID: PMC9140441 DOI: 10.3390/diagnostics12051241] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
Gestational diabetes mellitus (GDM) affects a total of 3% to 9% of all pregnancies. It has a high impact on both mother and baby, increases the perinatal risks, and predicts the presence of long-term chronic metabolic complications. The aim of our study is to determine the incidence of GDM in tertiary hospitals in the west part of Romania to lay out the risk factors associated with GDM and to observe the evolution of pregnancy among patients with this pathology by emphasizing the state of birth of the fetus, the birth weight, and the way of birth. We also want to compare the prevalence of GDM in preCOVID-19 (Coronavirus disease) versus COVID-19 years. The study took place between January 2017 and December 2021 at the Municipal Emergency Hospital of Timisoara, Romania. The proportion of births with GDM was significantly increased during the COVID-19 period compared to the preCOVID-19 period (chi2 Fisher exact test, p < 0.001). The period 2020−2021 represents a significant risk factor for GDM births (OR = 1.87, with 95% CI = [1.30, 2.67]). COVID years represent a risk period for developing gestational diabetes, which can be explained by reduced physical activity, anxiety, or modified dietary habits, even if the follow-up period was not impacted.
Collapse
Affiliation(s)
- Sorina Chelu
- Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.C.); (C.B.)
| | - Elena Bernad
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Marius Craina
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Radu Neamtu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Adelina Geanina Mocanu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Corina Vernic
- Computer Science and Medical Biostatistics Discipline, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Veronica Daniela Chiriac
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
- Correspondence: ; Tel.: +40-722-379-832
| | - Larisa Tomescu
- Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (E.B.); (M.C.); (R.N.); (A.G.M.); (L.T.)
| | - Claudia Borza
- Discipline of Pathophysiology, Victor Babes University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.C.); (C.B.)
| |
Collapse
|