Risk of major congenital heart disease in pregestational maternal diabetes is modified by hemoglobin A1c
Key result
Pregestational diabetes is linked to ~180% greater risk of major congenital heart disease.
- RR 2.8
- 95% CI 2.1-3.7
- P<0.0001
- n=594,773
Why the study?
The association between pregestational diabetes and congenital heart disease is recognized, but the importance of glycemic control and coexisting risk factors during pregnancy is less clear.
Does pregestational diabetes mellitus and poor first-trimester glycemic control increase the risk of major congenital heart disease in offspring?
Population
594 773 registered births in Alberta, Canada
Comparison
Pregestational diabetes and first-trimester HbA1c levels vs no diabetes or normal HbA1c
Design
Registry-based cohort study
Follow-up
Within 1 year of birth
Authors
Discussion
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Member takes
Implication
PDM with poor first-trimester control was associated with higher mCHD risk; extends observational data but requires interventional confirmation before practice change.
Study Design
Type
Cohort (n=594,773)
Structured PICO
Does pregestational diabetes mellitus and poor first-trimester glycemic control increase the risk of major congenital heart disease in offspring?
P
Population
594,773 registered births in Alberta, Canada, including 7,497 pregnancies complicated by pregestational diabetes mellitus (PDM).
I
Intervention
Pregestational diabetes mellitus (PDM) and first-trimester hemoglobin A1c (HbA1c) levels
C
Comparator
Pregnancies without diabetes, or PDM with normal HbA1c (≤ 6.1%)
O
Outcome
Incidence of major congenital heart disease (mCHD) requiring surgery within 1 year of birth or resulting in pregnancy termination or fetal demisehard clinical
Main Result
Effect estimate: RR 2.8 (95% CI 2.1-3.7)
p-value: p=<0.0001
Pregestational diabetes mellitus significantly increases the risk of major congenital heart disease in offspring, with the risk strongly modified by first-trimester glycemic control (HbA1c).
Cite This Study
He et al. (2023) conducted a cohort in Pregestational diabetes mellitus (n=594,773). Pregestational diabetes mellitus vs. No diabetes was evaluated on Major congenital heart disease requiring surgery within 1 year of birth or resulting in pregnancy termination or fetal demise (RR 2.8, 95% CI 2.1-3.7, p=<0.0001). Pregestational diabetes mellitus increased the risk of major congenital heart disease (RR 2.8; 95% CI 2.1-3.7), with risk rising to an adjusted RR of 8.5 in mothers with first-trimester HbA1c >8.0%.