Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. An international clinical collaboration, literature review, and meta-analysis

Herz. 2010 Jan;35(1):19-26. doi: 10.1007/s00059-010-3244-3. Epub 2010 Feb 9.

Abstract

Purpose: Investigation of the incidence and distribution of congenital structural cardiac malformations among the offspring of mothers with diabetes type 1 and of the influence of periconceptional glycemic control.

Methods: Multicenter retrospective clinical study, literature review, and meta-analysis. The incidence and pattern of congenital heart disease in the own study population and in the literature on the offspring of type 1 diabetic mothers were compared with the incidence and spectrum of the various cardiovascular defects in the offspring of nondiabetic mothers as registered by EUROCAT Northern Netherlands. Medical records were, in addition, reviewed for HbA(1c) during the 1st trimester.

Results: The distribution of congenital heart anomalies in the own diabetic study population was in accordance with the distribution encountered in the literature. This distribution differed considerably from that in the nondiabetic population. Approximately half the cardiovascular defects were conotruncal anomalies. The authors' study demonstrated a remarkable increase in the likelihood of visceral heterotaxia and variants of single ventricle among these patients. As expected, elevated HbA(1c) values during the 1st trimester were associated with offspring fetal cardiovascular defects.

Conclusion: This study shows an increased likelihood of specific heart anomalies, namely transposition of the great arteries, persistent truncus arteriosus, visceral heterotaxia and single ventricle, among offspring of diabetic mothers. This suggests a profound teratogenic effect at a very early stage in cardiogenesis. The study emphasizes the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease. Pregnancies with poor 1st-trimester glycemic control are more prone to the presence of fetal heart disease.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cross-Cultural Comparison*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diseases in Twins / diagnosis
  • Diseases in Twins / epidemiology
  • Europe
  • Female
  • Glycated Hemoglobin A / metabolism
  • Heart Defects, Congenital / blood
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / epidemiology*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Incidence
  • Infant, Newborn
  • Insulin / therapeutic use
  • Netherlands
  • Pregnancy
  • Pregnancy in Diabetics / blood
  • Pregnancy in Diabetics / diagnosis
  • Pregnancy in Diabetics / drug therapy
  • Pregnancy in Diabetics / epidemiology*
  • Pregnancy, Multiple
  • Reference Values
  • Retrospective Studies
  • Risk
  • Risk Factors
  • Ultrasonography, Prenatal
  • United States

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human