Birth Defects Registry, New York State Department of Health, Albany, New York, USA.
Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA.
Birth Defects Res. 2023 Jan 1;115(1):56-66. doi: 10.1002/bdr2.2050. Epub 2022 Jun 6.
Previous studies found consistent associations between pregestational diabetes and birth defects. Given the different biological mechanisms for type 1 (PGD1) and type 2 (PGD2) diabetes, we used National Birth Defects Prevention Study (NBDPS) data to estimate associations by diabetes type.
The NBDPS was a study of major birth defects that included pregnancies with estimated delivery dates from October 1997 to December 2011. We compared self-reported PGD1 and PGD2 for 29,024 birth defect cases and 10,898 live-born controls. For case groups with ≥5 exposed cases, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between specific defects and each diabetes type. We calculated crude ORs (cORs) and 95% CIs with Firth's penalized likelihood for case groups with 3-4 exposed cases.
Overall, 252 (0.9%) cases and 24 (0.2%) control mothers reported PGD1, and 357 (1.2%) cases and 34 (0.3%) control mothers reported PGD2. PGD1 was associated with 22/26 defects examined and PGD2 was associated with 29/39 defects examined. Adjusted ORs ranged from 1.6 to 70.4 for PGD1 and from 1.6 to 59.9 for PGD2. We observed the strongest aORs for sacral agenesis (PGD1: 70.4, 32.3-147; PGD2: 59.9, 25.4-135). For both PGD1 and PGD2, we observed elevated aORs in every body system we evaluated, including central nervous system, orofacial, eye, genitourinary, gastrointestinal, musculoskeletal, and cardiac defects.
We observed positive associations between both PGD1 and PGD2 and birth defects across multiple body systems. Future studies should focus on the role of glycemic control in birth defect risk to inform prevention efforts.
先前的研究发现，孕前糖尿病与出生缺陷之间存在一致的关联。鉴于 1 型（PGD1）和 2 型（PGD2）糖尿病的生物学机制不同，我们使用国家出生缺陷预防研究（NBDPS）的数据来估计按糖尿病类型划分的关联。
NBDPS 是一项对重大出生缺陷的研究，包括 1997 年 10 月至 2011 年 12 月预计分娩日期的妊娠。我们比较了 29024 例出生缺陷病例和 10898 例活产对照中自我报告的 PGD1 和 PGD2。对于病例组中暴露病例数≥5 的病例，我们估计了特定缺陷与每种糖尿病类型之间的关联的调整比值比（aOR）和 95%置信区间（CI）。我们使用 Firth 惩罚似然法计算了暴露病例数为 3-4 的病例组的粗比值比（cOR）和 95%CI。
总体而言，252（0.9%）例病例和 24（0.2%）例对照母亲报告了 PGD1，357（1.2%）例病例和 34（0.3%）例对照母亲报告了 PGD2。PGD1 与检查的 26 种缺陷中的 22 种相关，PGD2 与检查的 39 种缺陷中的 29 种相关。PGD1 的调整比值比范围为 1.6 至 70.4，PGD2 的调整比值比范围为 1.6 至 59.9。我们观察到骶骨发育不全的最强调整比值比（PGD1：70.4，32.3-147；PGD2：59.9，25.4-135）。对于 PGD1 和 PGD2，我们在评估的每个身体系统中都观察到了升高的调整比值比，包括中枢神经系统、口面、眼部、泌尿生殖系统、胃肠道、肌肉骨骼和心脏缺陷。
我们观察到 PGD1 和 PGD2 与多个身体系统的出生缺陷之间存在正相关关系。未来的研究应侧重于血糖控制在出生缺陷风险中的作用，以为预防工作提供信息。
