Maternal Gestational Diabetes and Fetal Congenital Heart Disease: An Observational Study

Background: Maternal type 1 diabetes mellitus (DM) is a recognised risk factor for the development of fetal congenital heart disease (CHD). However the risk of CHD in babies of women with gestational diabetes mellitus (GDM) is less well known. Objectives: The aim of this 10 year, retrospective, observational study was to compare the occurrence of congenital heart disease in these two referral groups and to evaluate whether detailed fetal echocardiography should be offered to women with GDM. Results: During the study period 1401 women with type 1 DM were referred for fetal echocardiography and a fetal congenital heart defect was diagnosed in 44 cases (3.1%). In the GDM cohort 543 women were referred for screening and 15 cases (2.76%) of fetal CHD were detected. Conclusions: Based on our data we consider women with GDM to be at an increased risk of having a baby with CHD. This risk might be due to a combination of hyperglycaemia, insulin resistance, an elevated BMI and more importantly, undiagnosed pre-gestational diabetes. Until more detailed data from larger studies is available, we will continue to accept these women as referrals for detailed fetal echocardiography. *Corresponding author: Gurleen Sharland, Department of Congenital Heart Disease, Evelina London Children’s Hospital, Westminster Bridge Road, London SE1 7EH, UK, Tel: 020 718 82308; Fax: 020 718 82307; E-mail: [email protected] Received: October 12, 2014; Accepted: January 26, 2015; Published: January 26, 2015 Citation: Hunter LE, Sharland GK (2015) Maternal Gestational Diabetes and Fetal Congenital Heart Disease: An Observational Study. J Preg Child Health 2: 132. doi:10.4172/2376-127X.1000132 Copyright: © 2015 Hunter LE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. increase in perinatal and maternal morbidity [10,11]. The combination of physiological, lifestyle, ethnic and genetic factors predisposes some women to develop gestational diabetes mellitus (GDM) [12]. Risk factors include a previous infant with a birth weight >4kg, maternal BMI >30, age > 25 years, previous GDM, family history of DM, certain ethnic groups, essential or pregnancy related hypertension, unexplained stillbirth/miscarriages and glycosuria. However, there is an absence of risk factors in approximately 50% of women. Women with type 1 DM are often referred for detailed fetal echocardiography because of the recognised risk for fetal CHD [13,14]. Women with GDM are also often referred to our unit for assessment of the fetal heart. Our initial hypothesis was that GDM was an inappropriate referral reason and women with GDM do not have an increased risk of CHD in their offspring. Therefore this observational study was undertaken to assess the occurrence of fetal CHD in women with reported gestational diabetes referred to our fetal cardiology unit and to evaluate whether fetal echocardiography should continue to be routinely offered to these women. Subjects and Methods This retrospective, observational study of data that had been prospectively acquired was undertaken in a tertiary fetal cardiology