Simeone Regina M, Devine Owen J, Marcinkevage Jessica A, Gilboa Suzanne M, Razzaghi Hilda, Bardenheier Barbara H, Sharma Andrea J, Honein Margaret A
National Center on Birth Defects and Developmental Disabilities; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
National Center on Birth Defects and Developmental Disabilities.
Am J Prev Med. 2015 Feb;48(2):195-204. doi: 10.1016/j.amepre.2014.09.002. Epub 2014 Oct 14.
Maternal pregestational diabetes (PGDM) is a risk factor for development of congenital heart defects (CHDs). Glycemic control before pregnancy reduces the risk of CHDs. A meta-analysis was used to estimate summary ORs and mathematical modeling was used to estimate population attributable fractions (PAFs) and the annual number of CHDs in the U.S. potentially preventable by establishing glycemic control before pregnancy.
A systematic search of the literature through December 2012 was conducted in 2012 and 2013. Case-control or cohort studies were included. Data were abstracted from 12 studies for a meta-analysis of all CHDs.
Summary estimates of the association between PGDM and CHDs and 95% credible intervals (95% CrIs) were developed using Bayesian random-effects meta-analyses for all CHDs and specific CHD subtypes. Posterior estimates of this association were combined with estimates of CHD prevalence to produce estimates of PAFs and annual prevented cases. Ninety-five percent uncertainty intervals (95% UIs) for estimates of the annual number of preventable cases were developed using Monte Carlo simulation. Analyses were conducted in 2013. The summary OR estimate for the association between PGDM and CHDs was 3.8 (95% CrI=3.0, 4.9). Approximately 2670 (95% UI=1795, 3795) cases of CHDs could potentially be prevented annually if all women in the U.S. with PGDM achieved glycemic control before pregnancy.
Estimates from this analysis suggest that preconception care of women with PGDM could have a measureable impact by reducing the number of infants born with CHDs.
孕前糖尿病（PGDM）是先天性心脏病（CHD）发生的一个危险因素。妊娠前血糖控制可降低CHD风险。本研究采用荟萃分析来估计汇总比值比（OR），并采用数学模型来估计人群归因分数（PAF）以及美国通过妊娠前建立血糖控制可能预防的CHD年发病数。
2012年和2013年对截至2012年12月的文献进行了系统检索。纳入病例对照研究或队列研究。从12项研究中提取数据用于所有CHD的荟萃分析。
采用贝叶斯随机效应荟萃分析得出PGDM与CHD之间关联的汇总估计值及95%可信区间（95% CrI），用于所有CHD及特定CHD亚型。该关联的后验估计值与CHD患病率估计值相结合，得出PAF和年度预防病例数的估计值。采用蒙特卡洛模拟得出可预防病例年发病数估计值的95%不确定区间（95% UI）。分析于2013年进行。PGDM与CHD之间关联的汇总OR估计值为3.8（95% CrI = 3.0, 4.9）。如果美国所有患有PGDM的女性在妊娠前实现血糖控制，每年大约可预防2670例（95% UI = 1795, 3795）CHD。
该分析的估计结果表明，对患有PGDM的女性进行孕前保健，通过减少患有CHD的婴儿出生数量，可能会产生可衡量的影响。
