Glycemic Control and Risk of Congenital Malformations in Women With Type 1 Diabetes.

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrics and gynecology Pub Date : 2024-09-05 DOI:10.1097/AOG.0000000000005722

Ida Holte Thorius, Janne Petersen, Lise Lotte N Husemoen, Amra C Alibegovic, Mari-Anne Gall, Peter Damm, Elisabeth R Mathiesen

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Abstract

Objective: To investigate the association between maternal glycemic control and the risk of congenital malformations in offspring of women with type 1 diabetes and to examine whether there is a hemoglobin A1C (Hb A1C) threshold value at which the risk for malformations increases significantly.

Methods: Analyses were performed on data from a multinational, observational cohort of 1,908 liveborn offspring of women with type 1 diabetes recruited in early pregnancy from 17 countries between 2013 and 2018. Offspring with malformations were identified according to European Surveillance of Congenital Anomalies version 1.4 and categorized as having one or more major malformations or minor malformations exclusively. The association between first-trimester Hb A1C levels and the risk of congenital malformations was investigated with splines in crude and adjusted logistic regression models.

Results: In total, 11.9% of the offspring (n=227) of women with type 1 diabetes had congenital malformations, including 2.1% (n=40) with at least one severe malformation. Women giving birth to offspring with malformations had a higher prevalence of psychiatric disorders (13.2% vs 7.2%, P<.01), thyroid disorders (33.0% vs 26.7%, P<.05), and folic acid supplementation (87.1% vs 77.7%, P<.01). The Hb A1C levels in the first trimester were similar (median 6.8% [interquartile range 6.3-7.6%] vs 6.7% [6.2-7.6%], P=.13) compared with women giving birth to offspring without malformations. The spline analysis illustrated a curvilinear association between Hb A1C levels and the risk of malformations with no clear threshold values. Higher first-trimester Hb A1C levels were associated with an increased risk of malformations (crude odds ratio [OR] 1.13, 95% CI, 1.01-1.27, adjusted odds ratio [aOR] 1.29, 95% CI, 1.10-1.51) and major malformations (crude OR 1.49, 95% CI, 1.23-1.81, aOR 1.57, 95% CI, 1.15-2.09).

Conclusion: An increased risk for congenital malformations was curvilinearly associated with higher Hb A1C levels in early pregnancy among women with type 1 diabetes without any threshold values identified.

Clinical trial registration: ClinicalTrials.gov, NCT01892319.

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1 型糖尿病女性患者的血糖控制与先天性畸形风险。

目的研究母体血糖控制与1型糖尿病女性后代先天性畸形风险之间的关系，并探讨是否存在一个血红蛋白A1C（Hb A1C）阈值，在该阈值处畸形风险会显著增加：对2013年至2018年期间从17个国家招募的1908名1型糖尿病女性早孕期活产后代的多国观察性队列数据进行了分析。根据欧洲先天性畸形监测1.4版确定了患有畸形的后代，并将其分为患有一种或多种主要畸形或仅患有轻微畸形。在粗略和调整后的逻辑回归模型中，使用劈叉法研究了第一胎血红蛋白 A1C 水平与先天性畸形风险之间的关系：1型糖尿病妇女的后代（样本数=227）中，共有11.9%患有先天性畸形，其中2.1%（样本数=40）至少患有一种严重畸形。生下畸形后代的妇女患精神疾病的比例更高（13.2% 对 7.2%，PC结论：在1型糖尿病妇女中，先天性畸形风险的增加与妊娠早期较高的血红蛋白A1C水平呈曲线关系，但未确定任何临界值：临床试验注册：ClinicalTrials.gov，NCT01892319。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obstetrics and gynecology 医学-妇产科学

CiteScore

11.10

自引率

4.20%

发文量

867

审稿时长

1 months

期刊介绍： "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.