Birth Defects and Pediatric Genetics Branch, Division of Birth Defects, Child Development, Disability and Health, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA.
To determine the relation between having an infant with a major heart defect and a mother's prepregnancy weight, we compared 1,049 Atlanta-area women who gave birth to liveborn or stillborn infants, each with a major heart defect, with 3,029 Atlanta-area women who gave birth to infants without birth defects. The infants of control women were randomly selected from birth certificates and were frequency-matched to the case group by race, birth hospital, and birth period from 1968 through 1980. After excluding diabetic mothers and adjusting for potential confounders, compared with average-weight women (body mass index 19.9-22.7), we found that underweight women (body mass index <16.5) were less likely to have a child with a major isolated heart defect [odds ratio (OR) = 0.64; 95% confidence interval (CI) = 0.43-0.97], whereas the OR was elevated among overweight or obese women (body mass index >26) (OR = 1.36; 95% CI = 0.95-1.93). Using average-weight women who did not take periconceptional multivitamins as the reference group, periconceptional multivitamin use was associated with a reduced OR for isolated heart defects among average-weight women (OR = 0.61, 95% CI = 0.36-0.99) and underweight women but not among overweight or obese women (OR = 1.69, 95% CI = 0.69-3.84).
"the overweight group was observed in this study, although the finding could be random, whereas maternal obesity was statistically significantly associated with orofacial clefts in the offspring (OR 1.30). The risk estimates concerning maternal obesity and neural tube defects range from 1.35 to 2.7 (Waller et al., 1994; Shaw et al., 1996; Källén, 1998; Watkins et al., 2003) and for maternal obesity and congenital cardiovascular malformations from 1.18 to 2.1 (Waller et al., 1994; Moore et al., 2000; Watkins et al., 2001, 2003; Cedergren and Källén, 2003). The association between maternal obesity and orofacial clefts was stronger when another major congenital defect was present than when the cleft was isolated, but an increased risk also was present for isolated clefts. "
[Show abstract][Hide abstract] ABSTRACT: To estimate whether obese women have an increased risk of orofacial clefts in their offspring, compared with average-weight women.
The study was based on information on maternal body mass index (BMI) collected in early pregnancy and on the existence of orofacial clefts in the offspring, ascertained from multiple sources. The study included 1686 women who had infants with an orofacial cleft and as controls all delivered women (n = 988,171) during the study period, 1992 through 2001. Infants with chromosome anomalies were excluded. The women were divided into underweight (BMI <19.8), average weight (reference group, BMI 19.8 to 26), overweight (BMI 26.1 to 29), and obese (BMI >29). Adjustments were made for year of birth, maternal age, parity, and maternal smoking.
Obese (BMI >29) mothers had an overall increased risk for having an infant with orofacial clefts: odds ratio 1.30 (95% confidence interval 1.11 to 1.53). This increased risk was higher when the cleft was associated with other major malformations than when it was isolated. There was no statistically significant difference between the risk estimates for cleft lip and cleft palate.
In this large sample, a positive association appears between maternal obesity in early pregnancy and orofacial clefts in the offspring. The explanation for this association is not known, but a relationship with undetected type 2 diabetes is one possibility.
"Results from that study led to the conclusion that there was no strong evidence to support the position that Vietnam veterans had a greater risk than other men of fathering babies with serious birth defects (Erickson et al. 1984). Other analyses from this large database have increased the understanding of a variety of risk factors associated with birth defects, such as maternal rubella infection during pregnancy (Cochi et al., 1989); maternal diabetes (Becerra et al., 1990); maternal obesity (Watkins et al., 2001); febrile illness during pregnancy (Botto et al., 2002; Lynberg et al., 1994); the use of vitamin A (Khoury et al., 1996), maternal alcohol use (Moore et al., 1997); and maternal smoking (Honein et al., 2000). From 1993–1997, MACDP served as a source of case data for the Birth Defects Risk Factors Surveillance project, a case-control study of birth defects that served as a precursor to the National Birth Defects Prevention Study (NBDPS) which began in 1997 (Yoon et al. 2001). "
[Show abstract][Hide abstract] ABSTRACT: The Metropolitan Atlanta Congenital Defects Program (MACDP) is a population-based birth defects surveillance program administered by the Centers for Disease Control and Prevention (CDC) that has been collecting, analyzing, and interpreting birth defects surveillance data since 1967. This paper presents an overview of MACDP current methods and accomplishments over the past 35 years.
MACDP actively monitors major birth defects among infants born to residents of five counties of metropolitan Atlanta, an area with approximately 50,000 annual births. Cases are ascertained from multiple sources, coded using a modified British Pediatric Association six-digit code, and reviewed and classified by clinical geneticists.
MACDP has monitored trends in birth defects rates and has served as a case registry for descriptive, risk factor, and prognostic studies of birth defects, including studies of Agent Orange exposure among Vietnam War veterans, maternal use of multivitamins, diabetes, febrile illnesses, and survival of children with neural tube defects. MACDP has served as a data source for one of the centers participating in the National Birth Defects Prevention Study, and for developing and evaluating neural tube defects prevention strategies related to the periconceptional use of folic acid supplements.
Since its inception, MACDP has served as a resource for the development of uniform methods and approaches to birth defect surveillance across the United States and in many other countries, monitoring birth defects rates, and as a case registry for various descriptive, etiologic, and survival studies of birth defects. MACDP has also served as a training ground for a large number of professionals active in birth defects epidemiology.
Birth Defects Research Part A Clinical and Molecular Teratology 10/2003; 67(9):617-24. DOI:10.1002/bdra.10111 · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study analysed the relationship between congenital malformations (CM) and severity of gestational diabetes mellitus.
A cohort of 2060 infants of mothers with gestational diabetes was studied. Universal screening and 3(rd) Workshop-Conference criteria were used to diagnose gestational diabetes. The severity of diabetes was assessed on the basis of previous hyperglycaemia, blood glucose values in diagnostic OGTT, area under the glucose curve, gestational age and HbA(1)c at diagnosis, insulin requirements during pregnancy, and OGTT after delivery. Potentially confounding variables (age, pre-pregnancy BMI, smoking) were considered. The relationship of potential predictors with CM was analysed with several multivariate logistic regression analyses.
The rate of CM was 6% for minor and 3.8% for major malformations (1.4% heart, 0.8% renal/urinary, 0.7% skeletal, 0.3% hypospadias, 0.2% central nervous system, 0.2% cleft lip/palate, 0.1% digestive tract, 0.3% other). In the final models, forward logistic regression analysis identified pre-pregnancy BMI as the predictor of CM (area under receiver operating characteristic curve 0.616); in the backward analysis additional predictors were 1-h blood glucose in diagnostic OGTT and gestational age at diagnosis (area under receiver operating characteristic curve 0.646). Both BMI and severity of gestational diabetes were predictors of heart and minor CM, whereas BMI predicted renal/urinary CM and severity of diabetes predicted skeletal CM.
In these infants of mothers with gestational diabetes, severity of diabetes and pre-pregnancy BMI were predictors of CM, in accordance with the well-documented pathogenic role of BMI (in the general population) and hyperglycaemia (in diabetic pregnancy). BMI was the main predictor of more prevalent CM.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.