Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis
| Autor: | Joel G. Ray, Wee-Shian Chan, T. E. O'brien |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Offspring Pregnancy in Diabetics Lower risk Preconception Care Folic Acid Pregnancy Risk Factors Diabetes mellitus Confidence Intervals medicine Humans Risk factor Prospective cohort study Glycemic Glycated Hemoglobin Gynecology Obstetrics business.industry Obstetrics and Gynecology Type 2 Diabetes Mellitus General Medicine medicine.disease Pregnancy Trimester First Diabetes Mellitus Type 1 Treatment Outcome Diabetes Mellitus Type 2 Meta-analysis Relative risk Female Smoking Cessation business Publication Bias Cohort study |
| Zdroj: | QJM. 94:435-444 |
| ISSN: | 1460-2393 |
| DOI: | 10.1093/qjmed/94.8.435 |
| Popis: | Preconception care (PCC) and strict periconceptional glycemic control are both used to minimize the risk of congenital birth defects in offspring of women with type 1 or type 2 diabetes mellitus (DM). These malformations are ascribed in large measure to poor periconceptional control. This study evaluated PCC by a meta-analysis of published studies of PCC in women with DM, published from 1970 to 2000. Two reviewers independently abstracted the data, and the rate and relative risk (RR) of major and minor malformations were pooled from eligible studies using a random effects model. Early first-trimester values of glycosylated hemoglobin were recorded. Eight retrospective and eight prospective cohort studies were included; they were carried out in Europe, the United Kingdom, the United States, and Israel. Most participants had type 1 DM, but three studies included women with type 2 DM. Women given PCC tended to be about 2 years older on average than the others. Methods of PCC were quite variable, although most centers provided some maternal education about the pregnancy risks associated with poor glycemic control. In seven studies reporting early gestational glycosylated hemoglobin values, mean levels were consistently lower in PCC patients. Among 2104 offspring, the pooled rate for major and minor anomalies was 2.4% in the PCC group and 7.7% in non-PCC recipients, for a pooled RR of 0.32. Among 2651 offspring, major malformations were less prevalent in the PCC group (2.1 vs. 6.5%; pooled RR = 0.36). Comparable results were obtained when only prospective studies were analyzed and in studies where the infant examiners were unaware of the mothers' PCC status. The lowest risk of major anomalies was in a study that administered folic acid periconceptionally to its PCC recipients; the RR was 0.11. This meta-analysis, which included both retrospective and prospective studies, demonstrates an association of PCC with a significantly lower risk of congenital anomalies in the offspring of women with established DM. The lowered risk was accompanied by significantly lower glycosylated hemoglobin values in the first trimester in recipients of PCC. |
| Databáze: | OpenAIRE |
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