PDF(Pubmed)
Abstract：
OBJECTIVE: To describe the frequency and types of congenital anomalies and associated risk factors in Brazilian women with type 2 diabetes.
METHODS: In this retrospective cohort study between 2005 and 2021, we included all pregnant participants with type 2 diabetes from the two major public hospitals in southern Brazil. We collected data from the electronic hospital records. Congenital anomalies were classified by the 10th revised International Classification of Diseases, Q chapter, enhanced by the EUROCAT registry classification, and categorized by type and gravity. We used multiple Poisson regression with robust estimates to estimate risks.
RESULTS: Among 648 participants, we excluded 19, and 62 were lost to follow-up; therefore, we included 567 participants. Overt diabetes arose in 191 participants (33.7%, 95% CI 30.0% - 38.0%). Less than 20% of the participants supplemented folate. Congenital anomalies occurred in 78 neonates (13.8%, CI 11.0 - 16.9%), 73 babies (93.6%) presented major anomalies, and 20 (10.5%) cases occurred in participants with overt diabetes. Cardiac anomalies were the most frequent (43 isolated and 12 combined). Pre-eclampsia was associated with an increased risk in the analyses including all women (adjusted RR 1.87 (95% CI 1.23-2.85), p = 0.003), but not in analyses including only women with an HbA1c measured up to the 14th gestational age. HbA1c, either measured at any time in pregnancy (adjusted RR 1.21 (95% CI 1.10-1.33), p < 0.001) or up to the first 14 weeks (adjusted RR 1.22, 95% CI 1.10-1.35, p < 0.001) was the only sustained risk factor. Risk factors such as maternal age, obesity, diabetes diagnosis, or use of antidiabetic medications were not associated with congenital anomalies.
CONCLUSIONS: We found a high frequency of congenital anomalies associated with poor maternal glycemic control and revealed an almost universal lack of preconception care. An urgent call to action is mandatory for the reversal of this gray scenario.
METHODS: In this retrospective cohort study between 2005 and 2021, we included all pregnant participants with type 2 diabetes from the two major public hospitals in southern Brazil. We collected data from the electronic hospital records. Congenital anomalies were classified by the 10th revised International Classification of Diseases, Q chapter, enhanced by the EUROCAT registry classification, and categorized by type and gravity. We used multiple Poisson regression with robust estimates to estimate risks.
RESULTS: Among 648 participants, we excluded 19, and 62 were lost to follow-up; therefore, we included 567 participants. Overt diabetes arose in 191 participants (33.7%, 95% CI 30.0% - 38.0%). Less than 20% of the participants supplemented folate. Congenital anomalies occurred in 78 neonates (13.8%, CI 11.0 - 16.9%), 73 babies (93.6%) presented major anomalies, and 20 (10.5%) cases occurred in participants with overt diabetes. Cardiac anomalies were the most frequent (43 isolated and 12 combined). Pre-eclampsia was associated with an increased risk in the analyses including all women (adjusted RR 1.87 (95% CI 1.23-2.85), p = 0.003), but not in analyses including only women with an HbA1c measured up to the 14th gestational age. HbA1c, either measured at any time in pregnancy (adjusted RR 1.21 (95% CI 1.10-1.33), p < 0.001) or up to the first 14 weeks (adjusted RR 1.22, 95% CI 1.10-1.35, p < 0.001) was the only sustained risk factor. Risk factors such as maternal age, obesity, diabetes diagnosis, or use of antidiabetic medications were not associated with congenital anomalies.
CONCLUSIONS: We found a high frequency of congenital anomalies associated with poor maternal glycemic control and revealed an almost universal lack of preconception care. An urgent call to action is mandatory for the reversal of this gray scenario.
摘要：
目的：描述巴西2型糖尿病女性先天性异常的频率和类型以及相关的危险因素。
方法：在2005年至2021年的这项回顾性队列研究中，我们纳入了巴西南部两家主要公立医院的所有2型糖尿病孕妇。我们从电子医院记录中收集数据。先天性畸形由第十次修订的国际疾病分类分类，Q章,由EUROCAT注册表分类增强，并按类型和重力分类。我们使用具有稳健估计的多元泊松回归来估计风险。
结果：在648名参与者中，我们排除了19例，有62例失去了随访；因此，我们包括567名参与者.191名参与者出现了明显的糖尿病(33.7%，95%CI30.0%-38.0%）。少于20%的参与者补充叶酸。先天性畸形发生在78例新生儿中(13.8%,CI11.0-16.9%），73名婴儿(93.6%)出现重大异常,20例(10.5%)发生在明显糖尿病患者中.心脏异常最常见（43例孤立，12例合并）。在包括所有女性在内的分析中，先兆子痫与风险增加相关(校正RR1.87(95%CI1.23-2.85),p=0.003),但不包括仅测量到第14胎龄的HbA1c女性的分析。HbA1c,在怀孕的任何时间测量(调整后的RR1.21(95%CI1.10-1.33)，p<0.001）或直到前14周（校正RR1.22，95％CI1.10-1.35，p<0.001）是唯一的持续风险因素。危险因素，如产妇年龄，肥胖，糖尿病诊断,或使用抗糖尿病药物与先天性异常无关.
结论：我们发现与产妇血糖控制不良相关的先天性异常的频率很高，并揭示了几乎普遍缺乏孕前护理。为了扭转这种灰色情景，必须紧急呼吁采取行动。
方法：在2005年至2021年的这项回顾性队列研究中，我们纳入了巴西南部两家主要公立医院的所有2型糖尿病孕妇。我们从电子医院记录中收集数据。先天性畸形由第十次修订的国际疾病分类分类，Q章,由EUROCAT注册表分类增强，并按类型和重力分类。我们使用具有稳健估计的多元泊松回归来估计风险。
结果：在648名参与者中，我们排除了19例，有62例失去了随访；因此，我们包括567名参与者.191名参与者出现了明显的糖尿病(33.7%，95%CI30.0%-38.0%）。少于20%的参与者补充叶酸。先天性畸形发生在78例新生儿中(13.8%,CI11.0-16.9%），73名婴儿(93.6%)出现重大异常,20例(10.5%)发生在明显糖尿病患者中.心脏异常最常见（43例孤立，12例合并）。在包括所有女性在内的分析中，先兆子痫与风险增加相关(校正RR1.87(95%CI1.23-2.85),p=0.003),但不包括仅测量到第14胎龄的HbA1c女性的分析。HbA1c,在怀孕的任何时间测量(调整后的RR1.21(95%CI1.10-1.33)，p<0.001）或直到前14周（校正RR1.22，95％CI1.10-1.35，p<0.001）是唯一的持续风险因素。危险因素，如产妇年龄，肥胖，糖尿病诊断,或使用抗糖尿病药物与先天性异常无关.
结论：我们发现与产妇血糖控制不良相关的先天性异常的频率很高，并揭示了几乎普遍缺乏孕前护理。为了扭转这种灰色情景，必须紧急呼吁采取行动。
