Higher Blood Glucose Values in Early Pregnancy Linked to Congenital Heart Disease in Offspring

Higher plasma glucose levels early in pregnancy increases the baby's risk of a congenital heart defect, even among mothers who do not have diabetes, according to a study published in The Journal of Pediatrics.

For many years, physicians have known that women with diabetes face an increased risk of giving birth to babies with heart defects. However, the current study is the first to examine this question in the earliest part of pregnancy, when the fetal heart is forming.

"Most women who have a child with congenital heart disease are not diabetic," said senior author James Priest, MD, Stanford University School of Medicine, Stanford, California. "We found that in women who don't already have diabetes or develop diabetes during pregnancy, we can still measure risk for having a child with congenital heart disease by looking at their glucose values during the first trimester of pregnancy."

One challenge associated with conducting the research was the fact that maternal blood glucose is not routinely measured in pregnant women without diabetes. Instead, women typically receive an oral glucose tolerance test halfway through pregnancy to determine whether they have gestational diabetes, but this test is performed well after the fetal heart has formed.

Dr. Priest and colleagues studied medical records from 19,107 pairs of mothers and their babies born between 2009 and 2015. The records included details of the mothers' prenatal care, including blood test results and any cardiac diagnoses made for the babies during pregnancy or after birth.

Infants with certain genetic diseases, those born from multiple pregnancies, and those whose mothers had extremely low or high body-mass-index measures were not included in the study.

Of the infants in the study, 811 were diagnosed with congenital heart disease, and the remaining 18,296 were not.

The researchers analysed blood glucose levels from any blood sample collected from the mothers between 4 weeks prior to the estimated date of conception and the end of the 14th gestational week, just after the completion of the first trimester of pregnancy. These early blood glucose measurements were available for 2,292 (13%) of women in the study. The researchers also looked at the results of oral glucose tolerance tests performed around 20 weeks of gestation, which were available for 9,511 of the women in the study.

After excluding women who had diabetes before pregnancy or who developed it during pregnancy, the results showed that the risk of giving birth to a child with a congenital heart defect was elevated by 8% for every increase of 10 mg/dL in blood glucose levels in the early stages of pregnancy.

Dr. Priest said that the next step in the research is to conduct a prospective study that follows a large group of women through pregnancy to see if the results are confirmed. If they see the same relationship, it may be helpful to measure blood glucose early in pregnancy in all pregnant women to help determine which individuals are at greater risk for having a baby with a heart defect.

"We could use blood glucose information to select women for whom a screening of the fetal heart could be helpful," said Dr. Priest. "Knowing about defects prenatally improves outcomes because mothers can receive specialised care that increases their babies' chances of being healthier after birth."

Reference: http://dx.doi.org/10.1016/j.jpeds.2017.10.046

SOURCE: Stanford University Medical Center