Impact of Maternal Diabetes on the Incidence of Critical Congenital Heart Disease in the United States

BACKGROUND: Critical congenital heart disease (CCHD) represents a significant subset of congenital heart disease (CHD). While the association between maternal diabetes mellitus and offspring CHD is well established, the specific relationship between maternal diabetes and CCHD remains underexplored. OBJECTIVES: This study aims to investigate the association between maternal diabetes and the incidence of offspring CCHD. METHODS: We analyzed natality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) from 2016 to 2021. The data set included information on maternal and paternal attributes, pregnancy history, prenatal care, and congenital anomalies among newborns. We included all live births in the United States, focusing on single births at a gestational age of ≥20 weeks. Multivariable logistic regression was used to explore the relationship between gestational diabetes, pregestational diabetes, and CCHD. RESULTS: Among 22,646,079 live births, 13,533 cases of CCHD were identified, with an incidence of 6 per 10,000 live births. Pregestational diabetes was associated with a 4.33-fold higher risk of CCHD (aOR: 4.33; 95% CI: 3.93-4.76), and gestational diabetes with a 1.47-fold higher risk (aOR: 1.47; 95% CI: 1.38-1.57). Additional risk factors included pregestational hypertension, gestational hypertension, and late initiation of antenatal care. A longer gestational age was associated with a lower risk of CCHD. CONCLUSIONS: Maternal diabetes, both pregestational and gestational, significantly increases the risk of CCHD. These findings highlight the need for targeted interventions and monitoring of diabetic mothers to mitigate the risk of CCHD in their offspring.