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Pregestational diabetes associated with increased risk for multiple types of birth defects

National study findings support preconception care for women with diabetes, obesity.

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Women with pregestational diabetes are three to four times more likely to have a child with one or multiple birth defects compared with mothers with no diabetes, according to study results published in the American Journal of Obstetrics and Gynecology.

In the National Birth Defects Prevention Study, CDC researchers examined the association between diabetes and birth defects in 13,030 mothers of infants born with birth defects and 4,895 mothers of infants born with no birth defects.

The CDC researchers reported that mothers with pregestational diabetes were more likely to have infants with a wide range of birth defects, and gestational diabetes was associated with a limited group of birth defects. The researchers considered 39 birth defects, isolated or multiple, including defects of the heart, brain, spine, kidney, oral cleft, gastrointestinal tract and limb.

“The continued association of diabetes with a number of birth defects highlights the importance of increasing the number of women who receive the best possible preconception care, especially for those women diagnosed with diabetes,” Adolfo Correa, MD, MPH, PhD, said in a press release.

“Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children,” said Correa, study author and epidemiologist at the CDC National Center on Birth Defects and Developmental Disabilities.

Birth defects

Pregestational diabetes was associated with about 50% of the birth defect categories analyzed — seven of 23 isolated noncardiac defects and 11 of 16 isolated cardiac defects (OR =3.17), and 13 of 23 multiple noncardiac defects and eight of 16 multiple cardiac defects (OR=8.62).

Gestational diabetes, on the other hand, was associated with fewer types of birth defects — three of 23 isolated noncardiac defects and three of 16 isolated cardiac defects (OR=1.42), and three of 23 multiple noncardiac defects and two of 16 multiple cardiac defects (OR=1.50).

However, the associations with gestational diabetes were weaker and generally limited to offspring of women with prepregnancy obesity or BMI ≥25. Preconception care should also be considered for women with prepregnancy obesity to prevent birth defects and reduce the risk for complications, according to the researchers.

Because birth defects associated with diabetes are more likely to occur during the first trimester of pregnancy and before a diagnosis of gestational diabetes is made, the observed associations suggest that some of the mothers with gestational diabetes had undiagnosed diabetes before becoming pregnant, according to the researchers. The symptoms may have gone unnoticed until pregnancy.

“The importance of identifying and implementing effective detection, control and prevention strategies for impaired glucose tolerance among women of childbearing age cannot be overstated,” the researchers wrote.

Am J Obstet Gynecol. 2008;doi:10.1016/j.ajog.2008.06.028.