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Risks of specific congenital anomalies in offspring of mothers with preexisting diabetes

Risks of specific congenital anomalies in offspring of mothers with preexisting diabetes
Outcome Number of events Pre-gestational diabetes
Number of studies Pooled RR (95% CI) I2 (%) P value
Heterotaxia 1098 4 8.78 (6.66 to 11.56) 0.0 0.423
Conotruncal defects 5495 4 3.76 (2.58 to 5.48) 68.3 0.024
Truncus arteriosus 435 3 12.16 (7.52 to 19.68) 0.0 0.866
Transposition of great vessels 6700 9 3.25 (2.54 to 4.15) 15.9 0.301
Tetralogy of fallot 5360 6 3.46 (2.27 to 5.28) 64.4 0.015
APVR 1239 4 3.47 (2.13 to 5.64) 0.0 0.684
LVOT defects 6672 7 3.46 (2.59 to 4.62) 37.8 0.140
Coarctation of aorta 6606 5 3.35 (2.25 to 4.99) 61.4 0.035
Hypoplastic left heart 2319 4 2.23 (1.07 to 4.64) 64.0 0.040
RVOT defects 6163 7 3.41 (2.65 to 4.38) 20.9 0.270
Pulmonary artery anomalies 17,215 3 2.81 (2.48 to 3.18) 0.0 0.865
Pulmonary valve stenosis 7273 5 2.51 (1.51 to 4.17) 76.2 0.002
Septal defects 12,368 2 3.23 (2.20 to 4.74) 86.2 0.007
AVSD 5126 6 3.94 (2.95 to 5.26) 40.0 0.139
VSD 64,844 10 3.10 (2.32 to 4.16) 90.2 <0.001
ASD 91,683 7 3.12 (2.42 to 4.02) 81.9 <0.001
VSD + ASD 1089 2 6.36 (4.38 to 9.24) 0.0 0.527
Single ventricle 1228 4 5.91 (2.43 to 14.38) 80.2 0.002
Nervous system defects 42,339 9 2.54 (1.73 to 3.73) 94.8 <0.001
Neural tube defects 8791 6 2.74 (1.46 to 5.14) 75.5 0.001
Anencephaly 3859 3 2.72 (2.16 to 3.44) 0.0 0.416
Encephalocele 1108 3 5.53 (3.24 to 9.45) 52.8 0.120
Spina bifida 9948 8 1.89 (1.15 to 3.09) 71.1 0.001
Hydrocephaly 10,733 5 3.46 (1.62 to 7.42) 85.0 <0.001
Holoprosencephaly 301 2 18.18 (4.03 to 82.06) 66.3 0.085
Eye, ear, face, and neck defects 39,570 6 3.14 (2.90 to 3.39) 0.0 0.444
Orofacial clefts 6,602 5 1.27 (0.54 to 2.98) 90.4 <0.001
Cleft palate 11,259 6 1.75 (1.04 to 2.94) 74.6 0.001
Cleft lip with or without cleft palate 32,641 7 1.89 (1.22 to 2.92) 81.1 <0.001
Digestive system defects 14,286 7 2.02 (1.24 to 3.28) 92.3 <0.001
Diaphragmatic hernia 5882 3 1.66 (1.32 to 2.10) 0.0 0.520
Abdominal wall defects 1691 2 1.31 (0.80 to 2.15) 0.0 0.729
Omphalocele 4163 3 1.90 (1.48 to 2.44) 0.0 0.447
Gastroschisis 9268 3 0.92 (0.68 to 1.24) 0.0 0.399
Genitourinary system defects 128,657 10 1.73 (1.35 to 2.21) 89.2 <0.001
Renal agenesis/dysgenesis 5239 6 5.63 (2.48 to 12.76) 86.1 <0.001
Hypospadias 44,963 9 1.57 (1.22 to 2.02) 74.1 <0.001
CAKUT 4143 3 1.80 (1.41 to 2.30) 0.0 0.865
Musculoskeletal system defects 123,365 11 1.98 (1.45 to 2.72) 94.4 <0.001
Limb reduction 23,963 9 2.73 (1.98 to 3.76) 81.7 <0.001
Polydactyly/syndactyly 20,328 4 0.95 (0.57 to 1.57) 71.8 0.003
Multiple congenital anomalies 2448 5 3.06 (2.36 to 3.96) 39.6 0.158
Major congenital anomalies 52,171 6 2.14 (1.65 to 2.77) 81.8 <0.001
Rates (95% CI) of major groups and selected subtypes of congenital anomalies* in pregnancies of women with and without pre-existing diabetes per 1000 singleton pregnancies and relative risk (95% CI).
APVR: anomalous pulmonary venous return; ASD: atrial septal defect; AVSD: atrioventricular septal defect; CAKUT: congenital anomalies of the kidney and urinary tract; CHD: congenital heart defect; CI: confidence interval; LVOT: left ventricular outflow tract; RR: relative risk; RVOT: right ventricular outflow tract; VSD: ventricular septal defect.
* European Surveillance of Congenital Anomalies (EUROCAT) coding.
Adapted from: Zhang TN, Huang XM, Zhao XY, et al. Risks of specific congenital anomalies in offspring of women with diabetes: A systematic review and meta-analysis of population-based studies including over 80 million births. PLoS Med 2022; 19:e1003900. Copyright © The Authors. Available at: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003900 (Accessed on March 18, 2021). Adapted under the terms of the Creative Commons Attribution License 4.0.
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