The association between vascular complications during pregnancy in women with Type 1 diabetes and congenital malformations

Abstract

Aims To assess the association between vascular complications of diabetes and the risk of congenital malformations in pregnant women with Type 1 diabetes. Methods We conducted an observational retrospective cohort study in women with Type 1 diabetes who received care consecutively from three tertiary care diabetes‐in‐pregnancy clinics in Calgary, Alberta, Canada. Multivariable logistic regression was used to assess the association between vascular complications (retinopathy, nephropathy and pre‐existing hypertension) and congenital malformations in offspring of women with Type 1 diabetes. Results Of 232 women with Type 1 diabetes, 49 (21%) had at least one vascular complication and there were 52 babies with congenital malformations. Maternal age (31.8 ± 5.0 vs. 29.4 ± 4.7 years, P < 0.01), diabetes duration (20.9 ± 6.7 vs. 11.2 ± 7.4 years, P < 0.01) and pre‐eclampsia rate (12.5% vs. 1.3%, P < 0.01) were higher in mothers with vascular complications than in those without. Multivariable analyses showed that vascular complications were not associated with an increased risk of congenital malformations (odds ratio 1.16, 95% confidence interval 0.46 to 2.88). Conclusions Vascular complications are common, occurring in one‐fifth of pregnant women with Type 1 diabetes, and in this study do not appear to be associated with an increased risk of congenital malformations in children.

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…With the introduction of insulin, the number of low-birth-weight infants (SGA) from PGDM mothers was reduced. Babies with low birth weight generally indicated maternal severe diabetic vascular complications, hypertension, or renal disease [139][140][141][142]. A too rigorous treatment of diabetes may lead to periodic hypoglycemia that may also be a cause of low birth weight [112].…”

A Florida public health‐based endocrine clinic for low‐income pregnant women with diabetes

“…It is especially concerning that 12 of 27 women with pregestational diabetes had early pregnancy HbA1Cs ≥ 8.0%, of which six had alarming early pregnancy HbA1C levels ≥ 10.0%; only six had recommended HbA1Cs < 6.5%. These entry HbA1C values indicate poor glycemic control during early pregnancy, increasing risks for pregnancy loss and fetal malformations (Callec et al., 2014; Jovanovič et al., 2015; Samii et al., 2019). The mean HbA1C levels while accessing ESC services decreased significantly from entry HbA1C levels in women with pregestational diabetes, with only one having a mean HbA1C value > 8.0% while under ESC care.…”

“…Women with pregestational diabetes face personal risks for treatment‐related hypoglycemia (Murphy et al., 2007), ketoacidosis (Morrison et al, 2017), myocardial infarction (Elkayam et al., 2014), pregnancy‐associated progression of microvascular complications including nephropathy (Klemetti et al, 2015) and retinopathy (Sugiyama et al., 2014), as well as heightened risks for pre‐eclampsia and surgical delivery (Jovanovič et al, 2015; Sugiyama et al., 2014). HbA1C elevation greater than 6.5% at the time of conception and during organogenesis is associated with spontaneous abortion and major congenital malformations including anencephaly, spina bifida, congenital heart defects, and skeletal deformities (Callec, Perdriolle‐Galet, Sery, & Morel, 2014; Jovanovič et al., 2015; Samii et al., 2019). Neonatal consequences of all types of pregnancy‐associated diabetes include prematurity, respiratory distress, macrosomia, neonatal hypoglycemia, and hyperbilirubinemia (Battarbee, Venkatish, Allaga, & Boggess, 2020; Maresh et al., 2015).…”

Adverse pregnancy outcomes in women with diabetes-related microvascular disease and risks of disease progression in pregnancy: A systematic review and meta-analysis

“…Maternal outcomes. Pregnant women with preexisting diabetes and any microvascular complication were at significantly increased risk in preeclampsia (OR 5.89, 95% CI 3.85 to 9.02, p < 0.01, I 2 = 14%; 9 studies) [21,26,[45][46][47][48][49][50][51], preterm birth before 34 weeks' (OR 8.49, 95% CI 1.87 to 38.63, p = 0.01, I 2 = 46%; 3 studies) [21,47,49] and 37 weeks' (OR 2.29, 95% CI 1.85 to 2.83, p < 0.01, I 2 = 0%; 7 studies) [25,26,43,47,49,50,52], and cesarean birth (OR 5.40, 95% CI 2.48 to 11.78, p < 0.01, I 2 = 60%; 6 studies) [21,43,44,47,50,53] than those without any microvascular complication (Table 1). Findings were similar in sensitivity analyses that restricted the meta-analyses to only women with preexisting type 1 diabetes or only studies with low to medium risk of bias (Tables A and B in S6 Appendix).…”