Context
Maternal pregestational diabetes (PGDM) is a risk factor for development of congenital
heart defects (CHDs). Glycemic control before pregnancy reduces the risk of CHDs.
A meta-analysis was used to estimate summary ORs and mathematical modeling was used
to estimate population attributable fractions (PAFs) and the annual number of CHDs
in the U.S. potentially preventable by establishing glycemic control before pregnancy.
Evidence acquisition
A systematic search of the literature through December 2012 was conducted in 2012
and 2013. Case−control or cohort studies were included. Data were abstracted from
12 studies for a meta-analysis of all CHDs.
Evidence synthesis
Summary estimates of the association between PGDM and CHDs and 95% credible intervals
(95% CrIs) were developed using Bayesian random-effects meta-analyses for all CHDs
and specific CHD subtypes. Posterior estimates of this association were combined with
estimates of CHD prevalence to produce estimates of PAFs and annual prevented cases.
Ninety-five percent uncertainty intervals (95% UIs) for estimates of the annual number
of preventable cases were developed using Monte Carlo simulation. Analyses were conducted
in 2013. The summary OR estimate for the association between PGDM and CHDs was 3.8
(95% CrI=3.0, 4.9). Approximately 2670 (95% UI=1795, 3795) cases of CHDs could potentially
be prevented annually if all women in the U.S. with PGDM achieved glycemic control
before pregnancy.
Conclusions
Estimates from this analysis suggest that preconception care of women with PGDM could
have a measureable impact by reducing the number of infants born with CHDs.
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Article info
Publication history
Published online: October 13, 2014
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Published by Elsevier Inc.
