Cargando…
Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study
BACKGROUND—: Maternal diabetes mellitus is associated with an increased risk of offspring congenital heart defects (CHD); however, the causal mechanism is poorly understood. We further investigated this association in a Danish nationwide cohort. METHODS AND RESULTS—: In a national cohort study, we i...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890838/ https://www.ncbi.nlm.nih.gov/pubmed/27166384 http://dx.doi.org/10.1161/CIRCULATIONAHA.115.017465 |
_version_ | 1782435166604492800 |
---|---|
author | Øyen, Nina Diaz, Lars J. Leirgul, Elisabeth Boyd, Heather A. Priest, James Mathiesen, Elisabeth R. Quertermous, Thomas Wohlfahrt, Jan Melbye, Mads |
author_facet | Øyen, Nina Diaz, Lars J. Leirgul, Elisabeth Boyd, Heather A. Priest, James Mathiesen, Elisabeth R. Quertermous, Thomas Wohlfahrt, Jan Melbye, Mads |
author_sort | Øyen, Nina |
collection | PubMed |
description | BACKGROUND—: Maternal diabetes mellitus is associated with an increased risk of offspring congenital heart defects (CHD); however, the causal mechanism is poorly understood. We further investigated this association in a Danish nationwide cohort. METHODS AND RESULTS—: In a national cohort study, we identified 2 025 727 persons born from 1978 to 2011; among them were 7296 (0.36%) persons exposed to maternal pregestational diabetes mellitus. Pregestational diabetes mellitus was identified by using the National Patient Register and individual-level information on all prescriptions filled in Danish pharmacies. Persons with CHD (n=16 325) were assigned to embryologically related cardiac phenotypes. The CHD prevalence in the offspring of mothers with pregestational diabetes mellitus was 318 per 10 000 live births (n=232) in comparison with a baseline risk of 80 per 10 000; the adjusted relative risk for CHD was 4.00 (95% confidence interval, 3.51–4.53). The association was not modified by year of birth, maternal age at diabetes onset, or diabetes duration, and CHD risks associated with type 1 (insulin-dependent) and type 2 (insulin-independent) diabetes mellitus did not differ significantly. Persons born to women with previous acute diabetes complications had a higher CHD risk than those exposed to maternal diabetes mellitus without complications (relative risk, 7.62; 95% confidence interval, 5.23–10.6, and relative risk, 3.49; 95% confidence interval, 2.91–4.13, respectively; P=0.0004). All specific CHD phenotypes were associated with maternal pregestational diabetes mellitus (relative risk range, 2.74–13.8). CONCLUSIONS—: The profoundly increased CHD risk conferred by maternal pregestational diabetes mellitus neither changed over time nor differed by diabetes subtype. The association with acute pregestational diabetes complications was particularly strong, suggesting a role for glucose in the causal pathway. |
format | Online Article Text |
id | pubmed-4890838 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-48908382016-06-21 Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study Øyen, Nina Diaz, Lars J. Leirgul, Elisabeth Boyd, Heather A. Priest, James Mathiesen, Elisabeth R. Quertermous, Thomas Wohlfahrt, Jan Melbye, Mads Circulation Original Articles BACKGROUND—: Maternal diabetes mellitus is associated with an increased risk of offspring congenital heart defects (CHD); however, the causal mechanism is poorly understood. We further investigated this association in a Danish nationwide cohort. METHODS AND RESULTS—: In a national cohort study, we identified 2 025 727 persons born from 1978 to 2011; among them were 7296 (0.36%) persons exposed to maternal pregestational diabetes mellitus. Pregestational diabetes mellitus was identified by using the National Patient Register and individual-level information on all prescriptions filled in Danish pharmacies. Persons with CHD (n=16 325) were assigned to embryologically related cardiac phenotypes. The CHD prevalence in the offspring of mothers with pregestational diabetes mellitus was 318 per 10 000 live births (n=232) in comparison with a baseline risk of 80 per 10 000; the adjusted relative risk for CHD was 4.00 (95% confidence interval, 3.51–4.53). The association was not modified by year of birth, maternal age at diabetes onset, or diabetes duration, and CHD risks associated with type 1 (insulin-dependent) and type 2 (insulin-independent) diabetes mellitus did not differ significantly. Persons born to women with previous acute diabetes complications had a higher CHD risk than those exposed to maternal diabetes mellitus without complications (relative risk, 7.62; 95% confidence interval, 5.23–10.6, and relative risk, 3.49; 95% confidence interval, 2.91–4.13, respectively; P=0.0004). All specific CHD phenotypes were associated with maternal pregestational diabetes mellitus (relative risk range, 2.74–13.8). CONCLUSIONS—: The profoundly increased CHD risk conferred by maternal pregestational diabetes mellitus neither changed over time nor differed by diabetes subtype. The association with acute pregestational diabetes complications was particularly strong, suggesting a role for glucose in the causal pathway. Lippincott Williams & Wilkins 2016-06-07 2016-06-06 /pmc/articles/PMC4890838/ /pubmed/27166384 http://dx.doi.org/10.1161/CIRCULATIONAHA.115.017465 Text en © 2016 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. |
spellingShingle | Original Articles Øyen, Nina Diaz, Lars J. Leirgul, Elisabeth Boyd, Heather A. Priest, James Mathiesen, Elisabeth R. Quertermous, Thomas Wohlfahrt, Jan Melbye, Mads Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study |
title | Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study |
title_full | Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study |
title_fullStr | Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study |
title_full_unstemmed | Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study |
title_short | Prepregnancy Diabetes and Offspring Risk of Congenital Heart Disease: A Nationwide Cohort Study |
title_sort | prepregnancy diabetes and offspring risk of congenital heart disease: a nationwide cohort study |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890838/ https://www.ncbi.nlm.nih.gov/pubmed/27166384 http://dx.doi.org/10.1161/CIRCULATIONAHA.115.017465 |
work_keys_str_mv | AT øyennina prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT diazlarsj prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT leirgulelisabeth prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT boydheathera prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT priestjames prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT mathiesenelisabethr prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT quertermousthomas prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT wohlfahrtjan prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy AT melbyemads prepregnancydiabetesandoffspringriskofcongenitalheartdiseaseanationwidecohortstudy |