{
    "abstract": "The association between pregestational diabetes mellitus (PDM) and risk of congenital heart disease (CHD) is well recognized; however, the importance of glycemic control and other coexisting risk factors during pregnancy is less clear. We sought to determine the relative risk (RR) of major CHD (mCHD) among offspring from pregnancies complicated by PDM and the effect of first-trimester glycemic control on mCHD risk.\nWe determined the incidence of mCHD (requiring surgery within\u20091\u2009year of birth or resulting in pregnancy termination or fetal demise) among registered births in Alberta, Canada. Linkage of diabetes status, maximum hemoglobin A1c (HbA1c) at <\u200916\u2009weeks' gestation and other covariates was performed using data from the Alberta Perinatal Health Program registry. Risk of mCHD according to HbA1c was estimated as an adjusted RR (aRR), calculated using log-binomial modeling.\nOf 1412 cases of mCHD in 594\u2009773 (2.37/1000) births in the study period, mCHD was present in 48/7497 with PDM (6.4/1000; RR, 2.8 (95% CI, 2.1-3.7); P\u2009<\u20090.0001). In the entire cohort, increased maternal age (aRR, 1.03 (95% CI, 1.02-1.04); P\u2009<\u20090.0001) and multiple gestation (aRR, 1.37 (95% CI, 1.1-1.8); P\u2009=\u20090.02) were also associated with mCHD risk, whereas maternal prepregnancy weight >\u200991\u2009kg was not. The stratified risk for mCHD associated with HbA1c\u2009\u2264\u20096.1%, >\u20096.1-8.0% and >\u20098.0% was 4.2/1000, 6.8/1000 and 17.1/1000 PDM/gestational diabetes mellitus births, respectively; the aRR of mCHD associated with PDM and HbA1c\u2009>\u20098.0% was 8.5 (95% CI, 5.0-14.4) compared to those without diabetes and 5.5 (95% CI, 1.6-19.4) compared to PDM with normal HbA1c (\u2264\u20096.1%).\nPDM is associated with a RR of 2.8 for mCHD, increasing to 8.5 in those with HbA1c\u2009>\u20098%. These data should facilitate refinement of referral indications for high-risk pregnancy screening. \u00a9 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.",
    "authors": [
        {
            "affiliation": "Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.",
            "firstname": "R",
            "initials": "R",
            "lastname": "He"
        },
        {
            "affiliation": "Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.",
            "firstname": "L K",
            "initials": "LK",
            "lastname": "Hornberger"
        },
        {
            "affiliation": "Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.",
            "firstname": "A",
            "initials": "A",
            "lastname": "Kaur"
        },
        {
            "affiliation": "Alberta Perinatal Health Program, Alberta Health Services, AB, Canada.",
            "firstname": "S",
            "initials": "S",
            "lastname": "Crawford"
        },
        {
            "affiliation": "Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.",
            "firstname": "C",
            "initials": "C",
            "lastname": "Boehme"
        },
        {
            "affiliation": "Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.",
            "firstname": "A",
            "initials": "A",
            "lastname": "McBrien"
        },
        {
            "affiliation": "Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.",
            "firstname": "L",
            "initials": "L",
            "lastname": "Eckersley"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.",
    "doi": "10.1002/uog.27456",
    "journal": "Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology",
    "keywords": [
        "advanced maternal age",
        "congenital heart disease",
        "diabetes mellitus",
        "fetal cardiology",
        "glycemic control",
        "multiple gestation",
        "obesity",
        "pregestational diabetes"
    ],
    "methods": null,
    "publication_date": "2023-08-18",
    "pubmed_id": "37594210",
    "results": "Of 1412 cases of mCHD in 594\u2009773 (2.37/1000) births in the study period, mCHD was present in 48/7497 with PDM (6.4/1000; RR, 2.8 (95% CI, 2.1-3.7); P\u2009<\u20090.0001). In the entire cohort, increased maternal age (aRR, 1.03 (95% CI, 1.02-1.04); P\u2009<\u20090.0001) and multiple gestation (aRR, 1.37 (95% CI, 1.1-1.8); P\u2009=\u20090.02) were also associated with mCHD risk, whereas maternal prepregnancy weight >\u200991\u2009kg was not. The stratified risk for mCHD associated with HbA1c\u2009\u2264\u20096.1%, >\u20096.1-8.0% and >\u20098.0% was 4.2/1000, 6.8/1000 and 17.1/1000 PDM/gestational diabetes mellitus births, respectively; the aRR of mCHD associated with PDM and HbA1c\u2009>\u20098.0% was 8.5 (95% CI, 5.0-14.4) compared to those without diabetes and 5.5 (95% CI, 1.6-19.4) compared to PDM with normal HbA1c (\u2264\u20096.1%).",
    "title": "Risk of major congenital heart disease in pregestational maternal diabetes is modified by hemoglobin A1c.",
    "xml": "<Element 'PubmedArticle' at 0x78850504a8e0>"
}