Abstract
This study aimed to determine whether poor glycemic control in early pregnancy is associated with an increased risk of congenital heart disease (CHD) for infants of women with preexisting diabetes. A retrospective review examined two tertiary care centers of diabetic pregnancies that recorded early hemoglobin A1c (HbA1c) values (<20 weeks). The incidence of prenatally diagnosed CHD was calculated and stratified by HbA1c level. Poor glycemic control was defined as an HbA1c level of 8.5 % or higher. Fetal echocardiography was used to identify fetuses that resulted in infants with suspected CHD. Neonatal echocardiograms and pathology reports were reviewed for confirmation of the diagnosis. Of 535 patients, 30 (5.6 %) delivered an infant with confirmed CHD. Among the patients with poor glycemic control, 8.3 % (n = 17) delivered an infant with CHD, whereas 3.9 % (n = 13) of those with an HbA1c level lower than 8.5 % delivered an infant with CHD (p = 0.03). Poor glycemic control in early pregnancy is associated with an increased risk of CHD in offspring. The incidence of CHD in patients with adequate glycemic control still is sufficiently high to justify routine fetal echocardiography for all gravidas with preexisting diabetes regardless of HbA1c level.
Similar content being viewed by others
References
American College of Obstetricians and Gynecologists (2009) Ultrasonography in pregnancy. ACOG practice Bulletin no. 101. Obstet Gynecol 113:451–461
American Diabetes Association (2011) Standards of medical care in diabetes 2011. Diabetes Care 34:S11–S61
Carvalho JS, Mavrides E, Shinebourne EA, Campbell S, Thilaganothan B (2002) Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart 88:387–391
Chung CS, Myrianthopolos NC (1975) Effect of maternal diabetes on congenital malformations. Birth Defects 11:23–58
Ferencz C, Rubin JD, McCarter RJ, Brenner JI, Ca Neil, Perry LW, Hepner SE, Downing JW (1985) Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 121:31–36
Fuhrman K, Reiher H, Semmler K, Fisher F, Fisher M, Glockner E (1983) Prevention of congenital malformations in infants of diabetic mothers. Diabetes Care 6:219–223
Gardiner HM, Pasquini L, Wolferson J, Kulinskaya E, Li W, Henein M (2006) Increased periconceptual maternal glycated haemoglobin in diabetic mothers reduces fetal long axis cardiac function. Heart 92:1125–1130
Gladman G, McCridle BW, Boutin C, Smallhorn JF (1997) Fetal echocardiographic screening of diabetic pregnancies for congenital heart disease. Am J Perinatol 14:59–62
http://www.health.ri.gov/publications/databooks/2010BirthDefects.pdf. Accessed 27 December 2012
Jenkins T, Wapner R (2004) Prenatal diagnosis of congenital disorders. In: Creasy R, Resnik R (eds) Maternal-fetal medicine: principles and practice. WB Saunders Co., Philadelphia, pp 235–280
Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD (1991) Preconception care of diabetes: glycemic control prevents congenital anomalies. JAMA 265:731–736
Lisowski LA, Verheijen PM, Copel JA, Kleiman CS, Wassink S, Visser GHA, Meijboom EJ (2010) Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. An international clinical collaboration, literature review, and meta-analysis. Herz 35:19–26
Marek J, Tomek V, Skovranek J, Povysilava V, Samanek M (2011) Prenatal ultrasound screening of congenital heart disease in an unselected national population: a 21-year experience. Heart 97:124–130
Meyer-Wittkopt M, Simpson M, Sharland GK (1996) Incidence of congenital heart defects in fetuses of diabetic mothers: a retrospective study of 326 cases. Utrasound Obstet Gynocol 8:8–10
Miller E, Hare JW, Cloherty JP, Dunn PJ, Gleason RE, Soeldner JS, Kitzmiller JL (1981) Elevated maternal hemoglobin A1c in early pregnancy and major congenital abnormalities in infants of diabetic mothers. N Engl J Med 304:1331–1334
Mills JL, Knopp Rh, Simpson JL, Jovanovic-Peterson L, Metzger BE, Holmes LB, Aarons JH, Brown Z, Reed GF, Bieber FR, Allen M, Holzman I, Ober C, Peterson CM, Withiam MJ, Duckles A, Mueller-Heuback E, Polk BF (1988) Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis. N Engl J Med 318:671–676
Moller J (1990) Incidence of cardial malformations. In: Moller J, Neal W (eds) Fetal, neonatal, and infant cardiac disease. Appleton and Lange, Norwalk, pp 361–369
Ogge G, Galioti P, Maccanti S, Faggiano F, Todros T (2006) Prenatal screening for congenital heart disease with four-chamber and outflow-tract views: a multicenter study. Ultrasound Obstet Gynecol 28:779–784
Shields LE, Gan EA, Murphy HF, Sahn DJ, Moore TR (1993) The prognostic value of hemoglobin A1c in predicting fetal heart disease in diabetic pregnancies. Obstet Gynecol 81:954–957
Steel JM, Johnstone FD, Hepburn DA, Smith AF (1990) Can pregnancy care of diabetic women reduce the risk of abnormal babies? Br Med J 301:1070–1074
Tegnander E, Williams W, Johansen OJ, Blaas HG, Eik-Nes SH (2006) Prenatal detection of heart defects in a nonselected population if 30,149 fetuses: detection rates and outcome. Ultrasound Obstet Gynecol 27:252–265
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Starikov, R., Bohrer, J., Goh, W. et al. Hemoglobin A1c in Pregestational Diabetic Gravidas and the Risk of Congenital Heart Disease in the Fetus. Pediatr Cardiol 34, 1716–1722 (2013). https://doi.org/10.1007/s00246-013-0704-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-013-0704-6