Gestational diabetes is associated with the risk of offspring's congenital anomalies: a register-based cohort study

BACKGROUND

Gestational diabetes mellitus (GDM) is a common pregnancy-related disorder and a well-known risk factor for adverse pregnancy outcomes. There are conflicting findings on the association of GDM with the risk of congenital anomalies (CAs) in offspring. In this study, we aimed to determine study whether maternal GDM is associated with an increased risk of major CAs in offspring.

METHODS

This Finnish Gestational Diabetes (FinnGeDi) register-based study included 6,597 women with singleton pregnancies and a diagnosis of GDM and 51,981 singleton controls with no diabetes identified from the Finnish Medical Birth Register (MBR) in 2009. Data from MBR were combined in this study with the Register of Congenital Malformations, which includes the data of CAs. We used logistic regression to calculate odds ratios (OR) for CAs, together with their 95% confidence intervals (CIs), adjusting for maternal age, parity, pre-pregnancy body mass index (BMI), and maternal smoking status.

RESULTS

The risk of major CAs was higher in the GDM-exposed (n = 336, 5.09%) than in the non-exposed group (n = 2,255, 4.33%) (OR: 1.18, 95% CI: 1.05-1.33, p = 0.005). The adjusted OR (aOR) was 1.14 (95% CI: 1.00-1.30, p = 0.047). There was a higher overall prevalence of CAs, particularly chromosomal abnormalities (0.52% vs. 0.21%), in the GDM-exposed group (OR: 2.49, 95% Cl: 1.69-3.66, p < 0.001). The aOR was 1.93 (95% Cl: 1.25-2.99, p = 0.003).

CONCLUSIONS

Offspring exposed to GDM have a higher prevalence of major CAs. Of note, risk factors other than GDM, such as older maternal age and a higher pre-pregnancy BMI, diminished the between group differences in the prevalence of major CAs. Nevertheless, our findings suggest that offspring exposed to maternal GDM are more likely to be diagnosed with a chromosomal abnormality, independent of maternal age, parity, pre-pregnancy BMI, and smoking.

Target scan-the experience at saveetha medical college

INTRODUCTION

The identification of foetal anomalies in utero is important. The prenatal detection of such abnormalities, often aids in planning the appropriate obstetrical management.

OBJECTIVES

To evaluate the antenatal prevalence of the major congenital anomalies and the malformation patterns which were seen in low risk patients of our hospital population.

STUDY DESIGN

This was a cross-sectional and an observational study.

SETTINGS

This study was done in the Radiology and Obstetrics Department of Saveetha Medical College, India.

DURATION

It extended from June 2012 to Aug 2012.

SAMPLE SIZE

It was done on 250 patients.

RESULTS

The incidence of foetal anomalies in our study was 2.97%. The mean maternal/mean gestational age at diagnosis was 24.5years /20 weeks. Among the 250 cases, five cases had lethal anomalies and two cases had non lethal anomalies. The lethal anomalies were cystic hygroma, body stalk anomaly, multicystic kidney, non immune hydrops and a Dandy Walker variant. All of the patients were primi gravida, without any risk factors. Two non lethal anomalies which were found were a duplication cyst in the foetal abdomen and a single umbilical artery. Foetal kartotyping and foetal autopsies were done in two cases. The parents of the offsprings with the lethal anomalies were counseled and they decided to go for termination of the pregnancies. It was offered to them. For the non- lethal cases, complete postnatal work ups were done by the paediatrician.

CONCLUSION

The sonographic demonstration of a lethal foetal anomalies is mandatory, which may dramatically alter the obstetrical management and it also aids in the parental preparation. Future Scope: In our study, all the non compatible with life anomalies were seen in the young primi without any risk factors and hence, the environmental cause has to be studied.