Maternal diabetes increases children’s risk for congenital heart defects
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Key takeaways:
- Mothers with type 1 or type 2 diabetes are more likely to have offspring with a congenital heart defect.
- Maternal obesity increases the risk for three subtypes of congenital heart defects.
Mothers with type 1 or type 2 diabetes have increased risks for having children with a congenital heart defect, according to a study published in JAMA Network Open.
“Maternal type 1 diabetes is associated with a significant risk for all types of congenital heart malformations in the offspring, while maternal overweight and obesity are associated with a subtle risk increase for a few subtypes of congenital heart malformations,” Emmi Helle, MD, PhD, pediatric cardiologist, and Riitta Turunen, MD, PhD, resident in pediatrics in the stem cells and metabolism research program, faculty of medicine at University of Helsinki and the New Children’s Hospital at University of Helsinki, told Healio. “Although occurring often in parallel, maternal diabetes, and maternal overweight and obesity seem to be independent risk factors for congenital heart malformations in the offspring.”
Helle, Turunen and colleagues collected nationwide register data from all children born in Finland from 2006 to 2016 and their mothers. Isolated congenital heart defects occurring in children were obtained from the Register of Congenital Malformations. Maternal BMI and diabetes diagnoses were collected from the Medical Birth Register.
There were 620,751 children and 573,259 mothers aged 20 to 40 years included in the study. Of the children, 1.7% had an isolated congenital heart defect. The percentage of mothers with gestational diabetes increased from 10.3% in 2006 to 19.2% in 2016. The prevalence of type 2 diabetes was 0.1% in 2006 and 0.3% in 2016, and the prevalence of type 1 diabetes was 0.6% in 2006 and 0.7% in 2016. Gestational diabetes occurred among 8.2% of mothers with a normal BMI, 21.1% of those with overweight and 41.1% of mothers with obesity.
In multivariable regression analysis, offspring of mothers with type 1 diabetes (adjusted OR = 3.77; 95% CI, 3.26-4.36) or type 2 diabetes (aOR = 1.92; 95% CI, 1.34-2.75) had higher odds of congenital heart defects compared with offspring of mothers without diabetes.
“Prenatal ultrasound screening to identify congenital malformations in the offspring is especially important in expectant mothers with diabetes, obesity or overweight as prenatal diagnosis improves the prognosis of infants with congenital heart defects,” Helle and Turunen said. “Increasing public awareness of maternal risk factors for offspring’s congenital heart defects and prepregnancy counseling of those with increased risk may aid in prevention.”
Maternal overweight and obesity were not associated with increased likelihood for congenital heart defects. However, in a subgroup analysis examining specific congenital heart defects, maternal obesity was associated with higher odds for complex defects (aOR = 2.7; 95% CI, 1.14-6.43), left ventricular outflow tract obstruction (aOR = 1.24; 95% CI, 1.03-1.5) and right ventricular outflow tract obstruction (aOR = 1.31; 95% CI, 1.09-1.58) compared with a normal maternal BMI. Maternal overweight also increased the likelihood for left ventricular outflow tract obstruction compared with normal maternal BMI (aOR = 1.28; 95% CI, 1.1-1.49).
“The association between maternal overweight and obesity as a risk for malformations affecting the left and right outflow tract of the heart and complex heart defects warrants further mechanistic research to identify potentially modifiable risk factors,” Helle and Turunen said. “For example, studying maternal early pregnancy blood metabolomics and markers for oxidative stress could aid in identifying biomarkers associated with an increased risk.”
For more information:
Emmi Helle, MD, PhD, can be reached at emmi.helle@helsinki.fi.
Riitta Turunen, MD, PhD, can be reached at riitta.m.turunen@helsinki.fi.
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