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Association of DiGeorge anomaly and caudal dysplasia sequence in a neonate born to a diabetic mother

Published online by Cambridge University Press:  06 March 2012

Maria L. Dentici
Affiliation:
Department of Medical Genetics, Cardiology and Pathology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
Silvia Placidi
Affiliation:
Department of Pediatric Cardiology, University “La Sapienza”, Rome, Italy
Paola Francalanci
Affiliation:
Department of Medical Genetics, Cardiology and Pathology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
Rossella Capolino
Affiliation:
Department of Medical Genetics, Cardiology and Pathology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
Gabriele Rinelli
Affiliation:
Department of Medical Genetics, Cardiology and Pathology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
Bruno Marino
Affiliation:
Department of Pediatric Cardiology, University “La Sapienza”, Rome, Italy
Maria C. Digilio*
Affiliation:
Department of Medical Genetics, Cardiology and Pathology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
Bruno Dallapiccola
Affiliation:
Department of Medical Genetics, Cardiology and Pathology, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
*
Correspondence to: M. C. Digilio, MD, Department of Medical Genetics, Bambino Gesù Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy. Tel: +39 06 68592227; Fax: +39 06 68592004; E-mail: [email protected]

Abstract

Aim/objective

Several studies have demonstrated a significantly increased risk of specific patterns of congenital anomalies in infants born to diabetic mothers. In particular, caudal dysplasia sequence has been linked to pregnancy complicated by maternal diabetes. In addition, several cases of infants born to diabetic mothers presenting with features of DiGeorge anomaly have been reported. Infants with DiGeorge anomaly can display additional manifestations within the spectrum of caudal dysplasia sequence, including vertebral anomalies and renal agenesis.

Methods

We report a neonate presenting with the co-occurrence of features of both DiGeorge anomaly and caudal dysplasia sequence, born to a mother with poorly controlled insulin-dependent diabetes.

Results

The patient was affected by truncus arteriosus type A1 and hypertrophic cardiomyopathy.

Conclusion

Maternal diabetes can cause a spectrum of manifestations, expressing with isolated DiGeorge anomaly or caudal dysplasia sequence, with intermediate phenotypes or with the co-occurrence of both the congenital anomalies in the same patient. The present observations argue for a feasible link between truncus arteriosus with hypertrophic cardiomiopathy, DiGeorge anomaly, and maternal diabetes.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2012

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References

1. Becerra, JE, Khoury, MJ, Cordero, JF, Erickson, JD. Diabetes mellitus during pregnancy and the risk for specific birth defects: a population-based case-control study. Pediatrics 1990; 85: 19.CrossRefGoogle ScholarPubMed
2. Kucera, J. Rate and type of congenital anomalies among offspring of diabetic women. J Reprod Med 1971; 7: 6170.Google Scholar
3. Martinez-Frias, ML. Epidemiological analysis of outcomes of pregnancy in diabetic mothers: identification of the most characteristic and most frequent congenital anomalies. Am J Med Genet 1994; 51: 108113.Google Scholar
4. Martinez-Frias, ML, Bermejo, E, Rodriguez-Pinilla, E, Prieto, L, Frias, JL. Epidemiological analysis of outcomes of pregnancy in gestational diabetic mothers. Am J Med Genet 1998; 78: 140145.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
5. Loffredo, CA, Wilson, PD, Ferencz, C. Maternal diabetes: an independent risk factor for major cardiovascular malformations with increased mortality of affected infants. Teratology 2001; 64: 98106.CrossRefGoogle ScholarPubMed
6. Passarge, E, Lenz, W. Syndrome of caudal regression in infants of diabetic mothers: observations of further cases. Pediatrics 1966; 37: 672675.CrossRefGoogle ScholarPubMed
7. Gosseye, S, Golaire, MC, Verellen, G, van Lierde, M, Claus, D. Association of bilateral renal agenesis and DiGeorge syndrome in an infant of a diabetic mother. Helv Paediatr Acta 1982; 37: 471474.Google Scholar
8. Ferencz, C, Rubin, JD, McCarter, RJ, Clark, EB. Maternal diabetes and cardiovascular malformations: predominance of double outlet right ventricle and truncus arteriosus. Teratology 1990; 41: 319326.Google Scholar
9. Wilson, TA, Blethen, SL, Vallone, A, et al. DiGeorge anomaly with renal agenesis in infants of mothers with diabetes. Am J Med Genet 1993; 47: 10781082.Google Scholar
10. Digilio, MC, Marino, B, Formigari, R, Giannotti, A. Maternal diabetes causing DiGeorge anomaly and renal agenesis. Am J Med Genet 1995; 55: 513514.CrossRefGoogle ScholarPubMed
11. Kumar, A, Sapire, DW, Lockhart, LH, McCombs, J, Hawkins, HK, Van Mierop, LH. Atrioventricular septal defect with pulmonary atresia in DiGeorge anomaly: expansion of the cardiac phenotype. Am J Med Genet 1996; 61: 8991.Google Scholar
12. Wang, R, Martinez-Frias, ML, Graham, JM. Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence: a case-based and case-control approach. J Pediatr 2002; 141: 611617.CrossRefGoogle ScholarPubMed
13. Bohring, A, Lewin, SO, Reynolds, JF, et al. Polytopic anomalies with agenesis of the lower vertebral column. Am J Med Genet 1999; 87: 99114.Google Scholar
14. DiGeorge, AM. Discussion of a new concept of the cellular basis of immunology. J Pediatr 1965; 67: 907908.Google Scholar
15. Marino, B, Digilio, MC, Toscano, A, et al. Anatomic patterns of conotruncal defects associated with deletion 22q11. Genet Med 2001; 3: 4548.Google Scholar
16. Greenberg, F. DiGeorge syndrome: an historical review of clinical and cytogenetic features. J Med Genet 1993; 30: 803806.Google Scholar
17. Iserin, L, de Lonlay, P, Viot, G, et al. Prevalence of the microdeletion 22q11 in newborn infants with congenital conotruncal cardiac anomalies. Eur J Pediatr 1998; 157: 881884.Google Scholar
18. Ziolkowska, L, Kawalec, W, Turska-Kmiec, A. Chromosome 22q11.2 microdeletion in children with conotruncal heart defects: frequency, associated cardiovascular anomalies, and outcome following cardiac surgery. Eur J Pediatr 2008; 167: 11351140.CrossRefGoogle ScholarPubMed
19. Goldmuntz, E, Clark, BJ, Mitchell, LE, et al. Frequency of 22q11 deletions in patients with conotruncal defects. J Am Coll Cardiol 1998; 32: 492498.CrossRefGoogle ScholarPubMed
20. Anilkumar, A, Kappanayil, M, Thampi, M, Nampoothiri, S, Sundaram, K, Vasudevan, D. Variation in prevalence of chromosome 22q11 deletion in subtypes of conotruncal defect in 254 children. Acta Paediatr 2011; 100: 97100.Google Scholar
21. Welch, JP, Aterman, K. Syndrome of caudal regression: a review, including etiologic considerations and evidence of heterogeneity. Pediatr Pathol 1984; 2: 313327.Google Scholar
22. Finer, NN, Bowen, P, Dunbar, LG. Caudal regression anomalad (sacral agenesis) in siblings. Clin Genet 1978; 13: 353358.Google Scholar
23. Padmanbhan, R. Retinoic acid-induced caudal regression syndrome in the mouse fetus. Reprod Toxicol 1998; 12: 496498.Google Scholar
24. Stevenson, RE, Jones, KL, Phelan, MC, et al. Vascular steal: the pathogenic mechanism producing sirenomelia and associated defects of the viscera and soft tissue. Pediatrics 1986; 78: 451457.CrossRefGoogle Scholar
25. Cheatham, JP, McManus, BM, Kugler, JD, Hofshire, PJ. Hypoplastic left heart syndrome in an infant of diabetic mother: two-dimensional, pulsed Doppler, and contrast echocardiographic diagnosis. J Cardiovasc Ultrasound 1988; 7: 913.Google Scholar