Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence:: A case-based and case-control approach

Objectives: To determine if infants of diabetic mothers (IDM) are at increased risk For dysplastic ears and the oculo-auriculo-vertebral spectrum (OAVS). Study design: Cases of IDM with dysplastic external ears seen at Cedars-Sinai Medical Center were combined with case series in medical literature describing similar patients. Data from a large congenital birth defects registry in Spain were analyzed, and odds ratios (OR) for infants born to either a gestational or preconceptionally diabetic mother to have one of the studied malformations were calculated with 95% confidence intervals. Results: Among the 30 patients in the case series, 50.0% (15) had hemifacial microsomia; 46.7% (14) had hearing loss; 33.3% (10) had facial nerve palsy; 33.3% (10) had vertebral anomalies; 36.7% (11) had cardiovascular defects, of which 45% (5),were conotruncal defects; 6.7% (8) had renal anomalies; 13.3% (4) had limb defects (all radial ray hypoplasia); 10% (3) had DiGeorge sequence; 6.7% (2) had lateraility defects; and 6.7% (2) had imperforate anus. Within the cases from the birth defects registry, the odds ratio for OAV'S in infants of mothers with gestational diabetes mellitus was 2.28 (95% CI, 1.03-4.82, P = .03), and the OR for ear anomalies in these infants,was 1.21 (95% CI, 0.94-1.56, P = .13). When infants of mothers with preconceptionally diagnosed type 1 or 2 diabetes were considered, the OR for OAVS was 1.50 (95% CI, 0.08-9.99, P = .49), and the OR for dysplastic ears was 0.94 (95% CI, 0.48-1.81, P = .85). Conclusions: Our data indicate that OAVS occurs with a higher incidence in IDM than in the general population. Associated problems include hearing loss, athymia, and cardiac, renal, and limb malformations. Therefore, we recommend that an IDM with features consistent with OAV'S undergo a workup including hearing evaluation, skeletal survey, echocardiogram, renal ultrasonogram, and immunodeficiency workup if clinically indicated. Furthermore, noting that most of these defects occur in structures of neural crest origin, we hypothesize that poorly controlled maternal diabetes interferes,with cephalic neural crest cell migration.