Maternal prepregnancy weight as an independent risk factor for congenital heart defect: systematic review and meta-analysis stratified by subtype and severity of defect

Clinical features of overt versus diagnosed pre-existing diabetes in pregnancy

Overt diabetes in pregnancy (ODP) was originally included in gestational diabetes mellitus, which was positioned between normal glucose tolerance and pre-existing diabetes mellitus (PDM) in perinatal risk. This retrospective study aimed to clarify the differences between women with ODP and those with PDM. Compared with women with PDM (n =  162), those with ODP (n = 76) had higher HbA1c levels especially in the first trimester (8.2 ± 1.5% vs 7.2 ± 1.5%; P < 0.001). Furthermore, women with ODP had higher pre-pregnancy body mass index (30.8 ± 7.0 vs 28.5 ± 5.6 kg/m2; P = 0.010), and a higher incidence of congenital anomalies (19.7% vs 9.3%; P = 0.035). In conclusion, ODP was not milder than PDM; women with ODP did not only have poorer glycemic control but also had poorer pre-pregnant weight control. Their burdens could be relieved through appropriate management before pregnancy.

Cardiac Manifestations in Children of Diabetic Mothers and Fathers

Diabetic individuals of reproductive age face higher risks of poor pregnancy outcomes and abnormal fetal development. Approximately 4.5% of women of reproductive age have diabetes, with non-Hispanic Black women having the highest prevalence of 15%. Research on the impact of paternal diabetes on offspring cardiac anomalies is limited, but it may interact with metabolic syndrome to increase long-term health risks. Infants of diabetic parents are more likely to develop cyanotic and acyanotic heart defects, hypertrophic cardiomyopathy, and subsequently other cardiovascular issues. Fetal hyperinsulinemia, caused by maternal hyperglycemia, contributes to these conditions through oxidative stress, impaired heart development, and cardiac remodeling. Long-term risks include diabetes, arrhythmias, pulmonary hypertension, heart failure, and early-onset cardiovascular disease. Treatment options are limited, often requiring surgery for severe conditions. Prevention focuses on tight glycemic control, a balanced diet, avoiding teratogens (nicotine, alcohol, or drugs), and using technology like continuous glucose monitors and insulin pumps, along with pregnancy screening and monitoring protocols. Understanding the effects of parental diabetes on offspring's cardiac health is crucial for early intervention, prevention, and improved maternal-fetal care, ultimately reducing the burden of congenital heart defects and long-term cardiovascular complications.

Conceiving during the first postoperative year after bariatric surgery: a retrospective study of pregnancy outcomes

BACKGROUND

An increasing number of childbearing-aged women have undergone bariatric surgery (BS). Although pregnancy outcomes generally improve after BS, concern remains over the impact of rapid weight loss and the catabolic state that occurs soon after BS. At least a 12-month surgery-to-conception time (SCT) is recommended, though the reasoning behind this has been questioned. This retrospective study was conducted to compare post-BS pregnancies with SCTs of less (Group 1) or more (Group 2) than 12 months.

METHODS

The Hospital Register and Finnish Medical Birth Register were queried for data on BS and subsequent pregnancies. The characteristics of women at surgery and maternal and newborn outcomes in post-BS pregnancies were collected.

RESULTS

Between 2010 and 2022, 113 women gave birth after BS. This included 17 and 96 patients in Groups 1 and 2. The mean SCTs were 8.0 ± 2.7 and 39.0 ± 24.3 months (p < 0.001), respectively. At BS, the characteristics of age (p = 0.316), weight (p = 0.718), body mass index (BMI) (p = 0.114) and surgical technique used (p = 0.648) were similar. During pregnancy, the mean age of Group 1 women was significantly lower (p = 0.005). With no difference in weight (p = 0.961) or BMI (p = 0.567), the incidence of gestational diabetes mellitus (GDM, p = 0.039) was higher in Group 2. The mean gestational age at delivery (p = 0.206) and incidence rates of preterm (p = 0.645), post-term (p = 1.00) and caesarean deliveries (p = 1.00) in the groups were similar. A significantly higher incidence of delivery induction (p < 0.001 was detected in Group 2. The mean newborn weight in Group 1 was lower (p = 0.038), but the mean birth weight standard deviation (p = 0.883) and incidences of low birth weight (< 2500 g, p = 0.345) and small-for-gestational-age newborns (p = 0.469) were similar. The 1- (p = 0.191) and 5-min (p = 0.174) Apgar points in the groups were similar, and no associations between pregnancy outcomes and surgery technique were detected.

CONCLUSIONS

The outcome in pregnancies with an SCT 12 months, postponing pregnancy may not always improve pregnancy outcomes. Therefore, all risks should be weighed when counselling women regarding the optimal time of pregnancy after BS.

Assisted reproductive technology and the risk of fetal congenital heart disease: insights from a tertiary-care referral center

PURPOSE

To investigate whether congenital heart diseases exhibit higher rates in pregnancies achieved through assisted reproductive technology (ART) compared to natural conception.

METHODS

In this retrospective cohort study, multinomial logistic regression was employed to analyze the relationship between categories of congenital heart diseases and three conception groups (IVF, ICSI, and natural pregnancies). The main outcome measures are risks of congenital heart disease categories in IVF and ICSI groups using the natural group as reference. We selected fetuses referred for fetal echocardiography to IRCCS Policlinico Sant'Orsola, Bologna, between January 2005 and November 2023, diagnosed with congenital heart diseases.

RESULTS

We categorized the congenital heart diseases into six groups based on anatomical and embryological criteria. The estimated risk of left ventricular outflow tract, valvular, conotruncal, and atrioventricular septal defects was lower in the IVF group compared to natural conception. The estimated risk of valvular and atrioventricular septal defects was lower in the ICSI group vs natural. Conversely, the risk for right heart anomalies was higher both in the IVF and ICSI groups compared to natural conception. Heart rhythm diseases were more frequent in IVF pregnancies. When comparing ART methods, valvular defects, conotruncal defects, and right heart anomalies were more frequently observed in the ICSI group, while atrioventricular septal defects were more common in the IVF group.

CONCLUSION

Significant differences were found in the occurrence of congenital heart diseases in pregnancies conceived through IVF and ICSI, versus those conceived naturally, underscoring the importance of further studying the underlying mechanisms of these associations.