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Diagnosis of fetal congenital malformations in pregestational diabetic pregnancies in the UK
  1. N Shah1,
  2. P Brydon2,
  3. C Shuter2,
  4. J Gardosi2
  1. 1Heart of England NHS Trust, Birmingham, UK
  2. 2West Midlands Perinatal Institute, Birmingham, UK

Abstract

Aim To categorise and investigate the effect of maternal ethnicity on major fetal congenital anomalies (CA) in mothers with type 1 and 2 diabetes from the West Midlands Diabetes in Pregnancy Cohort Study 2002–2003.

Methods Demographic, antenatal and outcome data for pregnancies registered in West Midlands region between 1 March 2002 and 28 February 2003 was obtained. The data regarding pregnancies resulting in a major fetal CA (ICD10 classification) were cross-checked with regional CA registry data, postmortem reports and postnatal paediatric examinations.

Result There were 32 major CAs in the cohort (426 babies; 370 registerable births). The congenital malformation rate (CMR) is 82.1/1000 births in the WM. There was no difference in the CMR for type 1 or type 2 maternal disease. 63% of these pregnancies resulted in a baby alive at 28 days. 78% of CAs occured in the European group, with the highest CMR being found in European mothers with type 2 diabetes (109/1000 total pregnancies). 13% of CAs occured in the South-Asian population and 6% only to Afrocaribbean mothers. The main categories of anomalies diagnosed were cardiac (37%), central nervous system (19%) and limb/musculoskeletal (16%). The antenatal detection rate by ultrasound for all cases and for cardiac cases only was 55–60%.

Conclusion In the WM the CMR is four times higher than the non-diabetic maternal population. Maternal ethnicity has a major influence on prevalence rates. Detailed ultrasound assessment, especially of the fetal heart, at 18–21-week gestation is mandatory to exclude major CA.

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