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Undiagnosed Maternal Diabetes Or Impaired Glucose Metabolism and Risk for Congenital Anomalies

出版	University of California, San Diego and San Diego State University, 2002
URL	http://books.google.com.hk/books?id=uRXtFEP9Rj0C&hl=&source=gbs_api

註釋The association between maternal diabetes and a 2-4 fold increased risk for major congenital anomalies in the offspring is well recognized. Although poor maternal glycemic control early in gestation is a strong predictor of fetal malformations, in some women more mild glucose intolerance may confer risk. Thus undiagnosed diabetes or impaired glucose tolerance may be an etiologic factor contributing to certain malformations for which there is no known cause. The purpose of this study was to examine the association between fetal pancreatic islet cell hyperplasia or hypertrophy as a marker for maternal-fetal hyperglycemia and selected major congenital anomalies that have previously been linked to maternal diabetes. The study population consisted of 427 fetuses or neonates whose mothers did not have a current or past diagnosis of diabetes and who were autopsied between the years 1988 and 2001 by the UCSD Autopsy Service. The prevalence of pancreatic islet cell hyperplasia/hypertrophy in fetuses or infants with diabetes-related congenital anomalies in each of nine malformation categories (n = 163) was compared to the prevalence in fetuses or infants whose malformations were attributed to known causes or whose demise was due to causes other than malformations (n = 264). A significantly higher prevalence of islet cell hyperplasia/hypertrophy in cases relative to controls was found for infants or fetuses>28 weeks gestational age in the following malformation categories: heart defects (adjusted OR 3.62, 95% CI, 1.21, 10.86), renal anomalies (adjusted OR 3.78, 95% CI, 1.14, 12.47), holoprosencephaly (adjusted OR 12.57, 95% CI, 2.22, 71.06), and multiple malformations (adjusted OR 3.32, 95% CI 1.06, 10.44). Adrenal gland weight was significantly increased in those with islet cell hyperplasia/hypertrophy, a finding also noted in infants of diabetic mothers. There were no significant associations between maternal pre-pregnancy weight, height, or glucose screening values; however, availability of this data was limited. These results suggest that undiagnosed diabetes and/or mild impairments in glucose tolerance may increase the risk for certain congenital anomalies. These data support the potential preventive value of universal screening in women of reproductive age and specific testing in mothers carrying fetuses with certain malformations.