Abstract 1665: Diabetes And Maternal Obesity Are Associated With Atrial Septal Defects In Newborns
Background Atrial septal defects (ASDs) are among the most common forms of congenital heart disease. Associations have been reported between atrial septal defects in newborns with maternal alcohol use and chemical exposures. We conducted a population based case-control study to evaluate the potential etiologic role of various maternal characteristics and behaviors with giving birth to an infant with an ASD.
Methods All singleton births in Western Washington State with a discharge diagnosis of ASD (n=1112) were identified from birth certificates and birth hospitalization discharge records during the period January 1, 1987 through December 31, 2005. A total of 4895 singleton births with no diagnosis of ASD at discharge and with a similar distribution of year of birth to the cases were selected as controls. Information on potential risk factors was obtained from birth certificates. Odds ratios were calculated for each potential risk factor. Adjustment for potential confounding was performed using the Mantel-Haenzel method.
Results Established maternal diabetes (OR 6.87, CI 3.64 – 12.96) and gestational diabetes (OR 1.88, CI 1.35 – 2.62) were associated with ASD. An increased risk was also found for mothers with BMI > 30 kg/m2 (OR 1.47, 1.22–1.76), and did not change appreciably when adjusting for diabetes. None of these findings were confounded by prematurity, birth weight, race, and geographic region. Restricting the analysis to infants with septum primum or sinus venosus ASDs, or those without known chromosomal abnormalities did not change our findings appreciably.
Discussion Diabetes was found to be strongly associated with ASDs. Although diabetes has been associated with other cardiovascular malformations, this is the first large study to confirm this association for ASDs. There are multiple pathways that have been postulated to explain the association of congenital heart malformations and diabetes. In the current study we were not able to examine whether the increased risk of ASDs was due to poor glycemic control, teratogenic effects of diabetic treatments, other etiologic factors associated with diabetes, or to increased clinical and echocardiographic screening of infants of diabetic mothers.