oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Periconception glycaemic control in women with type 1 diabetes and risk of major birth defects: population based cohort study in Sweden
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom; Department of Medicine, Columbia University, College of Physicians and Surgeons, New York NY, United States.ORCID iD: 0000-0003-1024-5602
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Sweden.
National Diabetes Register, Centre of Registers Västra Götaland, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Show others and affiliations
2018 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 362, article id k2638Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To examine the association between maternal type 1 diabetes and the risk of major birth defects according to levels of glycated haemoglobin (HbA1C) within three months before or after estimated conception.

DESIGN: Population based historical cohort study using nationwide health registers. SETTING Sweden, 2003-15.

PARTICIPANTS: 2458 singleton liveborn infants of mothers with type 1 diabetes and a glycated haemoglobin measurement within three months before or after estimated conception and 1 159 865 infants of mothers without diabetes.

MAIN OUTCOME MEASURES: Major cardiac and non-cardiac birth defects according to glycated haemoglobin levels.

RESULTS: 122 cases of major cardiac defects were observed among 2458 infants of mothers with type 1 diabetes. Compared with 15 cases of major cardiac defects per 1000 infants of mothers without diabetes, the rates among infants of mothers with type 1 diabetes were 33 per 1000 for a glycated haemoglobin level of <6.5% (adjusted risk ratio 2.17, 95% confidence interval 1.37 to 3.42), 49 per 1000 for 6.5% to <7.8% (3.17, 2.45 to 4.11), 44 per 1000 for 7.8% to <9.1% (2.79, 1.90 to 4.12), and 101 per 1000 for >= 9.1% (6.23, 4.32 to 9.00). The corresponding adjusted risk differences were 17 (5 to 36), 32 (21 to 46), 26 (13 to 46), and 77 (49 to 118) cases of major cardiac defects per 1000 infants, respectively. 50 cases of major non-cardiac defects were observed among infants of mothers with type 1 diabetes. Compared with 18 cases of major non-cardiac defects per 1000 infants of mothers without diabetes, the rates among infants of mothers with type 1 diabetes were 22 per 1000 for a glycated haemoglobin level of <6.5% (adjusted risk ratio 1.18, 0.68 to 2.07), 19 per 1000 for 6.5% to <7.8% (1.01, 0.66 to 1.54), 17 per 1000 for 7.8% to <9.1% (0.89, 0.46 to 1.69), and 32 per 1000 for >= 9.1%(1.68, 0.85 to 3.33).

CONCLUSIONS: Among liveborn infants of mothers with type 1 diabetes, increasingly worse glycaemic control in the three months before or after estimated conception was associated with a progressively increased risk of major cardiac defects. Even with glycated haemoglobin within target levels recommended by guidelines (<6.5%), the risk of major cardiac defects was increased more than twofold. The risk of major non-cardiac defects was not statistically significantly increased at any of the four glycated haemoglobin levels examined; the study had limited statistical power for this outcome and was based on live births only.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018. Vol. 362, article id k2638
National Category
General Practice Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-68243DOI: 10.1136/bmj.k2638ISI: 000438243200002PubMedID: 29976596Scopus ID: 2-s2.0-85049607960OAI: oai:DiVA.org:oru-68243DiVA, id: diva2:1235741
Funder
Swedish Diabetes AssociationSwedish Research Council, 2016-01974 2013-2429 2013-3770
Note

Funding Agencies:

Strategic Research Area Epidemiology Program at Karolinska Institutet

Stockholm County Council (ALF project)  20130156 

Available from: 2018-07-27 Created: 2018-07-27 Last updated: 2018-09-11Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Ludvigsson, Jonas F.

Search in DiVA

By author/editor
Ludvigsson, Jonas F.
By organisation
School of Medical SciencesÖrebro University Hospital
In the same journal
BMJ. British Medical Journal
General PracticeEndocrinology and Diabetes

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 85 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf