First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Family planning Unit, Third Department of Obstetrics and Gynaecology, Attiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):7685-7694. doi: 10.1080/14767058.2021.1960968. Epub 2021 Aug 6.
Maternal pregestational diabetes mellitus (PGDM), type 1 or type 2, has been established as a potential risk factor for congenital heart disease (CHD). At the same time, the correlation between gestational diabetes mellitus (GDM) and increased risk of CHD has not been yet fully elucidated. The objective of this systematic review and meta-analysis (PROSPERO number: CRD42020182390) was to analyze the existing evidence on PGDM and to attempt to fill, to the best of our ability, the remaining knowledge gap in the association of GDM with CHD.
Two authors have independently searched the Pubmed/Medline, Scopus, Cochrane, Web of Science, and Theses Global databases with keywords and Boolean operators. The search yielded 9333 relevant articles, which were later screened for eligibility. Original peer-reviewed (case-control or cohort) studies were included if they were published in English between 1997 and 2020. Thirteen studies on mothers with PGDM and seven studies on mothers with GDM were finally included in our meta-analysis to investigate the association of maternal diabetes with the risk of delivering a child with CHD. The selected studies were all assessed for their methodological quality using the Newcastle-Ottawa scale. Associations with < .05 were considered statistically significant.
Our meta-analysis ( > 75%, total population: = 12,461,586) of 79,476 women with PGDM and 160,893 with GDM produced an odds ratio of 3.48 (2.36-4.61) and 1.55 (1.48-1.61), respectively. Additionally, we did not find any noticeable difference in the risk for CHD among diabetic women living in the USA and Europe. Nevertheless, it still needs to be clarified, whether or not the gestational diabetic population includes undiagnosed women with preexisting diabetes, which might account for the increased risk of delivering a child with CHD in women classified as suffering from GDM.
While both GDM and PGDM seem to significantly increase the risk of CHD in comparison with the general population, PDGM appears to have a greater association with CHD, being correlated with a 3.5-fold increase in the risk of malformation. Preconceptional and gestational diabetes care are, therefore, essential to mitigate the adverse effect of hyperglycemia on fetal heart formation during pregnancy.
孕前糖尿病（PGDM），1 型或 2 型，已被确定为先天性心脏病（CHD）的潜在危险因素。同时，妊娠期糖尿病（GDM）与 CHD 风险增加之间的相关性尚未完全阐明。本系统评价和荟萃分析（PROSPERO 编号：CRD42020182390）的目的是分析现有的 PGDM 证据，并尝试尽可能填补 GDM 与 CHD 关联中仍然存在的知识空白。
两名作者分别使用关键词和布尔运算符独立搜索 Pubmed/Medline、Scopus、Cochrane、Web of Science 和 Theses Global 数据库。搜索产生了 9333 篇相关文章，随后对这些文章进行了资格筛选。如果原始同行评审（病例对照或队列）研究于 1997 年至 2020 年期间以英文发表，则将其纳入荟萃分析。最终纳入了 13 项关于患有 PGDM 的母亲的研究和 7 项关于患有 GDM 的母亲的研究，以调查母亲糖尿病与分娩患有 CHD 的孩子的风险之间的关联。使用纽卡斯尔-渥太华量表对所选研究进行了方法学质量评估。关联 <.05 被认为具有统计学意义。
我们对 79476 名患有 PGDM 的女性和 160893 名患有 GDM 的女性进行的荟萃分析（>75%，总人口：=12461586）得出的优势比分别为 3.48（2.36-4.61）和 1.55（1.48-1.61）。此外，我们没有发现美国和欧洲的糖尿病女性患 CHD 的风险有明显差异。然而，仍需要澄清的是，患有 GDM 的人群中是否包括未经诊断的患有先前存在的糖尿病的女性，这可能是导致被归类为患有 GDM 的女性分娩患有 CHD 的孩子的风险增加的原因。
虽然 GDM 和 PGDM 似乎都与一般人群相比显著增加 CHD 的风险，但 PGDM 似乎与 CHD 的关联更大，与畸形风险增加 3.5 倍相关。因此，孕前和妊娠期糖尿病护理对于减轻怀孕期间高血糖对胎儿心脏形成的不良影响至关重要。
