In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 2 ( 2022-2-1), p. e1003900-
Kurzfassung:
Pre-gestational diabetes mellitus (PGDM) has been known to be a risk factor for congenital heart defects (CHDs) for decades. However, the associations between maternal PGDM and gestational diabetes mellitus (GDM) and the risk of specific types of CHDs and congenital anomalies (CAs) in other systems remain under debate. We aimed to investigate type-specific CAs in offspring of women with diabetes and to examine the extent to which types of maternal diabetes are associated with increased risk of CAs in offspring. Methods and findings We searched PubMed and Embase from database inception to 15 October 2021 for population-based studies reporting on type-specific CAs in offspring born to women with PGDM (combined type 1 and 2) or GDM, with no limitation on language. Reviewers extracted data for relevant outcomes and performed random effects meta-analyses, subgroup analyses, and multivariable meta-regression. Risk of bias appraisal was performed using the Cochrane Risk of Bias Tool. This study was registered in PROSPERO (CRD42021229217). Primary outcomes were overall CAs and CHDs. Secondary outcomes were type-specific CAs. Overall, 59 population-based studies published from 1990 to 2021 with 80,437,056 participants met the inclusion criteria. Of the participants, 2,407,862 (3.0%) women had PGDM and 2,353,205 (2.9%) women had GDM. The meta-analyses showed increased risks of overall CAs/CHDs in offspring born to women with PGDM (for overall CAs, relative risk [RR] = 1.99, 95% CI 1.82 to 2.17, P 〈 0.001; for CHDs, RR = 3.46, 95% CI 2.77 to 4.32, P 〈 0.001) or GDM (for overall CAs, RR = 1.18, 95% CI 1.13 to 1.23, P 〈 0.001; for CHDs, RR = 1.50, 95% CI 1.38 to 1.64, P 〈 0.001). The results of the meta-regression analyses showed significant differences in RRs of CAs/CHDs in PGDM versus GDM (all P 〈 0.001). Of the 23 CA categories, excluding CHD-related categories, in offspring, maternal PGDM was associated with a significantly increased risk of CAs in 21 categories; the corresponding RRs ranged from 1.57 (for hypospadias, 95% CI 1.22 to 2.02) to 18.18 (for holoprosencephaly, 95% CI 4.03 to 82.06). Maternal GDM was associated with a small but significant increase in the risk of CAs in 9 categories; the corresponding RRs ranged from 1.14 (for limb reduction, 95% CI 1.06 to 1.23) to 5.70 (for heterotaxia, 95% CI 1.09 to 29.92). The main limitation of our analysis is that some high significant heterogeneity still persisted in both subgroup and sensitivity analyses. Conclusions In this study, we observed an increased rate of CAs in offspring of women with diabetes and noted the differences for PGDM versus GDM. The RRs of overall CAs and CHDs in offspring of women with PGDM were higher than those in offspring of women with GDM. Screening for diabetes in pregnant women may enable better glycemic control, and may enable identification of offspring at risk for CAs.
Materialart:
Online-Ressource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003900
DOI:
10.1371/journal.pmed.1003900.g001
DOI:
10.1371/journal.pmed.1003900.g002
DOI:
10.1371/journal.pmed.1003900.g003
DOI:
10.1371/journal.pmed.1003900.g004
DOI:
10.1371/journal.pmed.1003900.g005
DOI:
10.1371/journal.pmed.1003900.g006
DOI:
10.1371/journal.pmed.1003900.t001
DOI:
10.1371/journal.pmed.1003900.t002
DOI:
10.1371/journal.pmed.1003900.t003
DOI:
10.1371/journal.pmed.1003900.t004
DOI:
10.1371/journal.pmed.1003900.t005
DOI:
10.1371/journal.pmed.1003900.s001
DOI:
10.1371/journal.pmed.1003900.s002
DOI:
10.1371/journal.pmed.1003900.s003
DOI:
10.1371/journal.pmed.1003900.s004
DOI:
10.1371/journal.pmed.1003900.s005
DOI:
10.1371/journal.pmed.1003900.s006
DOI:
10.1371/journal.pmed.1003900.s007
DOI:
10.1371/journal.pmed.1003900.s008
DOI:
10.1371/journal.pmed.1003900.s009
DOI:
10.1371/journal.pmed.1003900.s010
DOI:
10.1371/journal.pmed.1003900.s011
DOI:
10.1371/journal.pmed.1003900.s012
DOI:
10.1371/journal.pmed.1003900.r001
DOI:
10.1371/journal.pmed.1003900.r002
DOI:
10.1371/journal.pmed.1003900.r003
DOI:
10.1371/journal.pmed.1003900.r004
DOI:
10.1371/journal.pmed.1003900.r005
DOI:
10.1371/journal.pmed.1003900.r006
DOI:
10.1371/journal.pmed.1003900.r007
DOI:
10.1371/journal.pmed.1003900.r008
Sprache:
Englisch
Verlag:
Public Library of Science (PLoS)
Publikationsdatum:
2022
ZDB Id:
2164823-2
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