Janssen P A, Rothman I, Schwartz S M
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Paediatr Perinat Epidemiol. 1996 Jan;10(1):52-63. doi: 10.1111/j.1365-3016.1996.tb00026.x.
We examined the relationship between diabetes in pregnancy and the development of congenital malformations, in a population-based retrospective study using birth certificate data for all liveborn children delivered from 1984 until 1991 in Washington State. Births to mothers with established and gestational diabetes numbered 1511 and 8869 respectively. For comparison we selected 8934 births to mothers without diabetes. The prevalence of congenital malformations in neonates was 7.2%, 2.8% and 2.1% among mothers with established diabetes, gestational diabetes, and without diabetes, respectively. Newborns of mothers with established diabetes were more likely to have a congenital malformation than newborns of non-diabetic mothers (prevalence odds ratio = 4.0; 95% confidence interval 3.1-5.1). In contrast, there was only a slightly higher prevalence of congenital malformations among newborns of mothers with gestational diabetes (prevalence odds ratio = 1.3; 95% CI 1.0-1.6). The association with maternal established diabetes was greater for neonates with multiple malformations (7.8; 95% CI 3.3-18.1) than for single malformations (2.9-95% CI 2.1-3.9). Four to seven fold associations were observed with skeletal, cleft lip/palate, neural tube and heart abnormalities. The association of established diabetes with congenital malformations was nearly twice as strong among female neonates (prevalence odds ratio = 5.4; 95% CI 3.7-8.0) than among male neonates (prevalence odds ratio = 3.1; 95% CI 2.2-4.5). No such variation was observed for associations with gestational diabetes. This study enlarges on previous work relating congenital anomalies to established diabetes and supports the possibility of a weak association with gestational diabetes.
我们在一项基于人群的回顾性研究中，利用华盛顿州1984年至1991年所有活产儿的出生证明数据，研究了妊娠糖尿病与先天性畸形发育之间的关系。患有确诊糖尿病和妊娠期糖尿病的母亲所生的婴儿分别为1511例和8869例。为作比较，我们选取了8934例母亲无糖尿病的分娩案例。确诊糖尿病母亲所生新生儿中先天性畸形的患病率为7.2%，妊娠期糖尿病母亲所生新生儿中为2.8%，无糖尿病母亲所生新生儿中为2.1%。患有确诊糖尿病母亲的新生儿比非糖尿病母亲的新生儿更易患先天性畸形（患病率比值比=4.0；95%置信区间3.1 - 5.1）。相比之下，妊娠期糖尿病母亲所生新生儿中先天性畸形的患病率仅略高（患病率比值比=1.3；95%置信区间1.0 - 1.6）。对于患有多种畸形的新生儿，与母亲确诊糖尿病的关联（7.8；95%置信区间3.3 - 18.1）大于单一畸形新生儿（2.9 - 95%置信区间2.1 - 3.9）。在骨骼、唇腭裂、神经管和心脏异常方面观察到4至7倍的关联。确诊糖尿病与先天性畸形的关联在女性新生儿中（患病率比值比=5.4；95%置信区间3.7 - 8.0）几乎是非男性新生儿中（患病率比值比=3.1；95%置信区间2.2 - 4.5）的两倍。在与妊娠期糖尿病的关联中未观察到此类差异。本研究扩展了先前关于先天性异常与确诊糖尿病关系的研究，并支持了与妊娠期糖尿病存在弱关联的可能性。
