Key Findings: Lack of Vitamins Containing Folic Acid and Diabetes-Associated Birth Defects

Recently, the American Journal of Obstetrics and Gynecology published a CDC study: “Lack of Periconceptional Vitamins or Supplements That Contain Folic Acid and Diabetes Mellitus-Associated Birth Defects”. You can read the abstract of the article here. The findings from this article are summarized in the following text.

Main study findings

Results from this study suggested that babies born to mothers with preexisting diabetes who did not take a vitamin containing folic acid might be at increased risk for birth defects compared with babies born to mothers with preexisting diabetes who did take a vitamin containing folic acid before and during early pregnancy.

However, the interpretation was limited by the relatively small number of mothers who had preexisting diabetes and did not use vitamins or supplements that contained folic acid and the lack of information on the level of diabetes control among these women.

Diabetes—A disease that affects the body’s blood sugar

Diabetes is a condition in which the body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. The body either makes no insulin or too little insulin or cannot use the insulin it makes to change those sugars and starches into energy. As a result, extra sugar builds up in the blood. Poor control of diabetes during pregnancy increases the chances for having a baby with a birth defect^1-3 and can result in other problems for the baby. It also can cause serious complications for the mother.

More than 60% of women with preexisting diabetes have unplanned pregnancies, lack access to prenatal care, or might have trouble keeping their blood sugar under control, or a combination thereof.^4-6 For these reasons, it is important to understand if other actions taken before and during pregnancy can help reduce the risk of having a baby with a birth defect for these women. A recommendation supported by the American Diabetes Association is for women with preexisting diabetes to consume 400 micrograms of folic acid daily if they are capable of becoming pregnant, and to increase their consumption to 600 micrograms of folic acid daily if they are pregnant or planning to become pregnant.^7,8 However, currently there is limited evidence to show that folic acid might reduce the risk of having a baby with a birth defect for women with diabetes.

In a previous study using data from the National Birth Defects Prevention Study (NBDPS), preexisting diabetes was reported by 0.5% of mothers of a baby born without a birth defect and 2.4% of mothers of a baby born with a birth defect; preexisting diabetes was responsible for a twofold to fourfold increased risk of a wide array of major birth defects.¹ In the current study, NBDPS researchers examined whether not taking vitamins containing folic acid before and during early pregnancy could increase the risk of having a baby with a birth defect among women with preexisting diabetes.

Diabetes during pregnancy: CDC activities

The CDC is working to address diabetes during pregnancy with the following activities:

• Research: CDC funds a large study of birth defects called the National Birth Defects Prevention Study. This study is working to identify risk factors for birth defects and to answer questions about the effects of diabetes during pregnancy.
• Materials Development: Through research, CDC has found that a lack of knowledge and awareness about the need to control diabetes before and during pregnancy exists among women and health care providers. As a result, CDC has created educational materials on gestational diabetes and preexisting diabetes and pregnancy, in both English and Spanish.

More information

To learn more about diabetes during pregnancy, please visit https://www.cdc.gov/pregnancy/diabetes.html
For more information about birth defects, please visit https://www.cdc.gov/birthdefects.
For more information about folic acid, please visit https://www.cdc.gov/folicacid.
For more information about diabetes, please visit https://www.cdc.gov/diabetes/.

References

1. Correa A, Gilboa SM, Besser LM, Botto LD, Moore CA, Hobbs CA, et al. Diabetes mellitus and birth defects. Am J Obstet Gynecol. 2008 Sep;199(3):237.e1-9.
2. Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986-2000: a population-based cohort study. Birth Defects Res A Clin Mol Teratol. 2005 Sep;73(9):605-11.
3. Sheffield JS, Butler-Koster EL, Casey BM, McIntire DD, Leveno KJ. Maternal diabetes mellitus and infant malformations. Obstet Gynecol. 2002 Nov;100(5 Pt 1):925-30.
4. Holing EV, Beyer CS, Brown ZA, Connell FA. Why don’t women with diabetes plan their pregnancies? Diabetes Care. 1998 Jun;21(6):889-95.
5. Coustan DR. Pre-conception planning: the relationship’s the thing. Diabetes Care. 1998 Jun; 21(6):887-8.
6. Janz NK, Herman WH, Becker MP, Charron-Prochownik D, Shayna VL, Lesnick TG, et al. Diabetes and pregnancy: Factors associated with seeking pre-conception care. Diabetes Care. 1995 Feb;18(2):157-65.
7. Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care. 2008 May;31(5): 1060-79.
8. Center for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Morb Mortal Wkly Rep. 1992 Sep;41(RR-14):1-7.

Reference for Key Findings Feature

Correa A, Gilboa SM, Botto LD, et al. Lack of periconceptional vitamins or supplements that contain folic acid and diabetes mellitus–associated birth defects. Am J Obstet Gynecol 2012 [epub ahead of print].