This study was designed to evaluate the effects of maternal obesity and diabetes mellitus on the risk of nonchromosomal congenital defects. We used data from 22,951 pregnant women enrolled in a prospective cohort study of early prenatal exposures and pregnancy outcome. The relative risks [prevalence ratios (PRs)] of major nonchromosomal congenital defects associated with obesity and diabetes, alone or in combination, were calculated using multiple logistic regression analysis. In this study, in the absence of diabetes, obese women (body mass index > or =28) had no higher risk, overall, of having an offspring with a major defect [PR = 0.95; 95% confidence interval (CI) = 0.62-1.5]. Their offspring, however, did have a higher prevalence of certain types of defects, including orofacial clefts; club foot; cardiac septal defects; and, to a lesser extent, hydrocephaly and abdominal wall defects. Women with pre-existing or gestational diabetes who were not obese also had no excess risk overall of having offspring affected by a major defect (PR = 0.98; 95% CI = 0.43-2.2), although they did have a higher prevalence of musculoskeletal defects. The pregnancies of women who were both obese and diabetic were 3.1 times as likely (95% CI = 1.2-7.6) to result in an offspring with a defect than were those of nonobese, nondiabetic women, which suggests that obesity and diabetes mellitus may act synergistically in the pathogenesis of congenital anomalies. The defects were largely craniofacial or musculoskeletal.

译文

本研究旨在评估母亲肥胖和糖尿病对非染色体先天性缺陷风险的影响。我们使用了来自22,951名参加产前早期暴露和妊娠结局的前瞻性队列研究的孕妇的数据。使用多元logistic回归分析计算单独或合并与肥胖和糖尿病相关的主要非染色体先天性缺陷的相对风险 [患病率 (PRs)]。在这项研究中,在没有糖尿病的情况下,肥胖妇女 (体重指数> 或 = 28) 总体上没有较高的风险,其后代具有重大缺陷 [PR = 0.95; 95% 置信区间 (CI) = 0.62-1.5]。但是,他们的后代确实存在某些类型的缺陷,包括口面部裂隙; 俱乐部足; 心脏间隔缺损; 以及在较小程度上的脑积水和腹壁缺损。既往或未肥胖的妊娠糖尿病女性也没有患主要缺陷 (PR = 0.98; 95% CI = 0.43-2.2) 的额外风险,尽管她们的肌肉骨骼缺陷患病率较高。肥胖和糖尿病妇女的怀孕导致后代缺陷的可能性是非肥胖,非糖尿病妇女的3.1倍 (95% CI = 1.2-7.6),这表明肥胖和糖尿病可能协同作用在先天性异常的发病机理中。缺陷主要是颅面或肌肉骨骼。

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