Bánhidy Ferenc, Acs Nándor, Puhó Erzsébet H, Czeizel Andrew E
Second Department of Obstetrics and Gynecology, Semmelweis, University, School of Medicine, Budapest, Hungary.
Congenit Anom (Kyoto). 2010 Jun;50(2):115-21. doi: 10.1111/j.1741-4520.2010.00275.x. Epub 2010 Feb 22.
To estimate the risk of structural birth defects (i.e. congenital abnormalities [CA]) in the offspring of pregnant women with type 1 (DM-1), type 2 (DM-2) and gestational diabetes mellitus (GDM) and to check the efficacy of recent specific care of diabetic pregnant women in the reduction of DM-related CA. Comparison was made of the occurrence of medically recorded types of diabetes mellitus in pregnant women who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. In the case group, which included 22 843 offspring, there were 79 (0.35%) pregnant women with DM-1, 77 (0.34%) pregnant women with DM-2 and 120 (0.53%) pregnant women with GDM. The control group comprised 38 151 newborns, and 88 (0.23%), 141 (0.37%) and 229 (0.60%) pregnant women with DM-1, DM-2 and GDM, respectively. The total rate of cases with CA was higher only in the DM-1 group (adjusted OR with 95% CI: 1.5, 1.1-2.0) and within four specific types/groups: isolated renal a/dysgenesis, obstructive CA of the urinary tract, cardiovascular CA and multiple CA; namely, caudal dysplasia sequence. The risk of total CA was lower in the present study compared to the risk in previous studies and the DM-1-related spectrum of CA was also different. There was no higher risk of total CA in the offspring of pregnant women with DM-2 and GDM. The certain part of maternal teratogenic effect of DM-1 is preventable with appropriate periconceptional and prenatal care of diabetic women.
评估1型糖尿病（DM-1）、2型糖尿病（DM-2）和妊娠期糖尿病（GDM）孕妇后代发生结构性出生缺陷（即先天性异常[CA]）的风险，并检验近期针对糖尿病孕妇的特定护理措施在降低糖尿病相关先天性异常方面的效果。在1980 - 1996年匈牙利基于人群的先天性异常病例对照监测系统中，比较了有畸形胎儿/新生儿的孕妇（病例组）和分娩健康婴儿的孕妇（对照组）中医学记录的糖尿病类型的发生情况。病例组包括22843名后代，其中有79名（0.35%）DM-1孕妇、77名（0.34%）DM-2孕妇和120名（0.53%）GDM孕妇。对照组包括38151名新生儿，其中分别有88名（0.23%）、141名（0.37%）和229名（0.60%）DM-1、DM-2和GDM孕妇。仅DM-1组先天性异常病例的总发生率较高（校正比值比及95%可信区间：1.5，1.1 - 2.0），且在四种特定类型/组中较高：孤立性肾发育不全/发育异常、泌尿系统梗阻性先天性异常、心血管先天性异常和多发先天性异常；即尾椎发育异常序列。与先前研究中的风险相比，本研究中先天性异常的总风险较低，且DM-1相关的先天性异常谱也有所不同。DM-2和GDM孕妇后代先天性异常的总风险没有更高。通过对糖尿病女性进行适当的孕前和产前护理，DM-1的部分母体致畸作用是可以预防的。
