Top

Published in:

01-05-2017

Pre-pregnancy Obesity as a Modifier of Gestational Diabetes and Birth Defects Associations: A Systematic Review

Published in: Maternal and Child Health Journal | Issue 5/2017

Abstract

Objective Inconsistent findings of associations between gestational diabetes mellitus (GDM) and birth defects suggest unaccounted confounders may underlie the actual basis for such associations. We conducted a systematic review to assess observed associations between GDM and birth defects and the extent to which these could be explained by pre-pregnancy obesity. Methods Using a combination of search terms for GDM and birth defects, we searched PubMed, Scopus, CINAHL, and ClinicalTrials.gov for human-based studies published through September 2013. Studies were eligible for inclusion if they included information on maternal diabetes status, method of diagnosis of GDM, and assessment of birth defects. Twenty-four of 768 potential articles were included. We collected information on study design, location and period, method of determination of diabetes status, types of birth defects, and measures of association reported. Results There was no evidence for consistent association of GDM with birth defects, with the exception of a weak association between GDM and congenital heart defects. When stratified by maternal pre-pregnancy BMI, an association between GDM and congenital heart defects and between GDM and neural tube defects was evident only in women with both GDM and pre-pregnancy obesity. Conclusions for Practice Our findings suggest reported associations between GDM and birth defects may be due, in part, to undiagnosed metabolic disorders associated with obesity, such as pregestational diabetes mellitus, rather than GDM. These findings highlight the need for increased efforts for pre-pregnancy screening for undiagnosed diabetes and awareness of the importance of weight management among women of childbearing age with obesity.

Aberg, A., Westbom, L., & Kallen, B. (2001). Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Human Development, 61(2), 85–95.CrossRefPubMed

Abolfazl, M., Hamidreza, T. S., Narges, M., & Maryam, Y. (2008). Gestational diabetes and its association with unpleasant outcomes of pregnancy. Pakistan Journal of Medical Sciences, 24(4), 566–570.

Agopian, A. J., Moulik, M., Gupta-Malhotra, M., Marengo, L. K., & Mitchell, L. E. (2012). Descriptive epidemiology of non-syndromic complete atrioventricular canal defects. Paediatric and Perinatal Epidemiology, 26(6), 515–524. doi:10.1111/ppe.12006.CrossRefPubMedPubMedCentral

Agopian, A. J., Tinker, S. C., Lupo, P. J., Canfield, M. A., & Mitchell, L. E. (2013). Proportion of neural tube defects attributable to known risk factors. Birth Defects Research Part A, 97(1), 42–46. Retrieved, from http://www.ncbi.nlm.nih.gov/pubmed/23427344.

Anderson, J. L., W, D. K., Canfield, M. A., Shaw, G. M., Watkins, M. L., & Werler, M. M. (2005). Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology, 16(1), 87–92.CrossRefPubMed

Aryasinghe, L., M, D., Ansari, T. A., Khoury, R., Mathew, E., Sharbatti, S. A., & Shaikh, R. B. (2012). Congenital anomalies at birth: A hospital based study in UAE. Journal of Nepal Paediatric Society, 32(2), 105–112.CrossRef

Correa, A., Gilboa, S. M., Besser, L. M., Botto, L. D., Moore, C. A., Hobbs, C. A., … Reece, E. A. (2008). Diabetes mellitus and birth defects. American Journal of Obstetrics and Gynecology, 199(3), 237.e231–239. doi:10.1016/j.ajog.2008.06.028.CrossRef

Correa, A., & Marcinkevage, J. (2013). Prepregnancy obesity and the risk of birth defects: An update. Nutrition Reviews, 71(Suppl 1), S68–77. doi:10.1111/nure.12058.CrossRefPubMed

Fadl, H. E., Ostlund, I. K., Magnuson, A. F., & Hanson, U. S. (2010). Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabetic Medicine, 27(4), 436–441. doi:10.1111/j.1464-5491.2010.02978.x.CrossRefPubMed

Ferencz, C., Rubin, J. D., McCarter, R. J., & Clark, E. B. (1990). Maternal diabetes and cardiovascular malformations: Predominance of double outlet right ventricle and truncus arteriosus. Teratology, 41(3), 319–326. doi:10.1002/tera.1420410309.CrossRefPubMed

Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception. doi:10.1016/j.contraception.2011.07.013.PubMedCentral

Garcia-Patterson, A., Erdozain, L., Ginovart, G., Adelantado, J. M., Cubero, J. M., Gallo, G., … Corcoy, R. (2004). In human gestational diabetes mellitus congenital malformations are related to pre-pregnancy body mass index and to severity of diabetes. Diabetologia, 47(3), 509–514. doi:10.1007/s00125-004-1337-3.CrossRefPubMed

Gasim, T. (2012). Gestational diabetes mellitus: maternal and perinatal outcomes in 220 saudi women. Oman Medical Journal, 27(2), 140–144. doi:10.5001/omj.2012.29.CrossRefPubMedPubMedCentral

Gilboa, S. M., Correa, A., Botto, L. D., Rasmussen, S. A., Waller, D. K., Hobbs, C. A., … Riehle-Colarusso, T. J. (2010). Association between prepregnancy body mass index and congenital heart defects. American Journal of Obstetrics and Gynecology, 202(1), 51.e51–51.e10. doi:10.1016/j.ajog.2009.08.005.CrossRef

Inkster, M. E., Fahey, T. P., Donnan, P. T., Leese, G. P., Mires, G. J., & Murphy, D. J. (2006). Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: Systematic review of observational studies. BMC Pregnancy and Childbirth, 6, 30. doi:10.1186/1471-2393-6-30.CrossRefPubMedPubMedCentral

Janssen, P. A., Rothman, I., & Schwartz, S. M. (1996). Congenital malformations in newborns of women with established and gestational diabetes in Washington State, 1984–91. Paediatric and Perinatal Epidemiology, 10(1), 52–63. Retrieved, from http://www.ncbi.nlm.nih.gov/pubmed/8746431.

Lapolla, A., Dalfra, M. G., Bonomo, M., Parretti, E., Mannino, D., Mello, G., & Di Cianni, G. (2009). Gestational diabetes mellitus in Italy: A multicenter study. European Journal of Obstetrics, Gynecology, and Reproductive Biology. doi:10.1016/j.ejogrb.2009.04.023.PubMed

Mannan, M. A., Rahman, M. H., Ara, I., & Afroz, H. (2012). Prevelence and pregnancy outcome of gestational diabetes mellitus among Bangladeshi urban pregnant women. Journal of Medicine (Bangladesh), 13(2), 147–151.

Martinez-Frias, M. L., Frias, J. P., Bermejo, E., Rodriguez-Pinilla, E., Prieto, L., & Frias, J. L. (2005). Pre-gestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes. Diabetic Medicine, 22(6), 775–781. doi:10.1111/j.1464-5491.2005.01492.x.CrossRefPubMed

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., The Prisma Group (2009). Preferred reporting items for systemic reviews and meta-analyses: The Prisma Statement. Journal of Clincal Epidemiology, 62, 1006–1012.CrossRef

Moore, L. L., Singer, M. R., Bradlee, M. L., Rothman, K. J., & Milunsky, A. (2000). A prospective study of the risk of congenital defects associated with maternal obesity and diabetes mellitus. Epidemiology, 11(6), 689–694.CrossRefPubMed

Mosher, W. D., Jones, J., & Abma, J. C. (2012). Intended and unintended births in the United States: 1982–2010. National Health Statistics Reports, 55, 1–28. Retrieved, from http://www.ncbi.nlm.nih.gov/pubmed/23115878.

Pablo Velazquez, G., Genero, V. M., & Martha Leticia Martinez, M. (2010). Neonatal morbidity and mortality associated with gestational diabetes. Revista Chilena de Obstetricia y Ginecologia, 75(1), 35–41.

Porter, M. P., Faizan, M. K., Grady, R. W., & Mueller, B. A. (2005). Hypospadias in Washington State: Maternal risk factors and prevalence trends. Pediatrics, 115(4), e495–e499. doi:10.1542/peds.2004-1552.CrossRefPubMed

Ramachandran, A., Snehalatha, C., Clementina, M., Sasikala, R., & Vijay, V. (1998). Foetal outcome in gestational diabetes in south Indians. Diabetes Research and Clinical Practice, 41(3), 185–189.CrossRefPubMed

Ramos-Arroyo, M. A., Rodriguez-Pinilla, E., & Cordero, J. F. (1992). Maternal diabetes: the risk for specific birth defects. European Journal Epidemiology, 8(4), 503–508. Retrieved, from http://www.ncbi.nlm.nih.gov/pubmed/1397216.

Reece, E. A., Ma, X. D., Wu, Y. K., & Dhanasekaran, D. (2002). Aberrant patterns of cellular communication in diabetes-induced embryopathy. I. Membrane signalling. The Journal of Maternal-Fetal & Neonatal Medicine, 11(4), 249–253. doi:10.1080/jmf.11.4.249.253.CrossRef

Reece, E. A., Ma, X. D., Zhao, Z., Wu, Y. K., & Dhanasekaran, D. (2005). Aberrant patterns of cellular communication in diabetes-induced embryopathy in rats: II, apoptotic pathways. American Journal of Obstetrics and Gynecology, 192(3), 967–972. doi:10.1016/j.ajog.2004.10.592.CrossRefPubMed

Savona-Ventura, C., & Gatt, M. (2004). Embryonal risks in gestational diabetes mellitus. Early Human Development, 79(1), 59–63. Retrieved, from http://www.ncbi.nlm.nih.gov/pubmed/15449398.

Sheffield, J. S., Butler Koster, E.L., Casey, B.M., McIntire, D.D., Leveno, K.J. (2002). Maternal diabetes mellitus and infant malformations. Obstetrics and Gynecology, 100(5), 925–930.PubMed

Shnorhavorian, M., Bittner, R., Wright, J. L., & Schwartz, S. M. (2011). Maternal risk factors for congenital urinary anomalies: Results of a population-based case-control study. Urology. doi:10.1016/j.urology.2011.04.022.PubMed

Stothard, K. J., Tennant, P. W., Bell, R., & Rankin, J. (2009). Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA, 301(6), 636–650. doi:10.1001/jama.2009.113.CrossRefPubMed

Van Bennekom, C. M., Mitchell, A. A., Moore, C. A., & Werler, M. M. (2013). Vasoactive exposures during pregnancy and risk of microtia. Birth Defects Research. Part A, 97(1), 53–59. doi:10.1002/bdra.23101.CrossRefPubMed

Title: Pre-pregnancy Obesity as a Modifier of Gestational Diabetes and Birth Defects Associations: A Systematic Review
Publication date: 01-05-2017
Published in: Maternal and Child Health Journal / Issue 5/2017
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-016-2209-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pre-pregnancy Obesity as a Modifier of Gestational Diabetes and Birth Defects Associations: A Systematic Review

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2017

Challenges and Progress in Building a Comprehensive Statewide System for Fetal Alcohol Spectrum Disorders Prevention in Hawai‘i

Sociocultural and Environmental Influences on Brazilian Immigrant Mothers’ Beliefs and Practices Related to Child Feeding and Weight Status

The Influence of Pregnancy on Sweet Taste Perception and Plaque Acidogenicity

Residential Neighborhood Amenities and Physical Activity Among U.S. Children with Special Health Care Needs

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms

Improving Maternal and Infant Child Health Outcomes with Community-Based Pregnancy Support Groups: Outcomes from Moms2B Ohio