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Editor,—In a recent paper Narchi and Kulaylat1 analysed the prevalence (erroneously termed incidence2) of trisomy 21 in children of mothers with diabetes (7/1870) and in non-diabetic mothers (28/20 430) and found it to be significantly higher in the former. All seven cases in the diabetes group occurred in mothers with gestational diabetes.
The authors concluded, that: (1) Maternal gestational diabetes is an independent risk factor for Down’s syndrome, irrespective of maternal age, as in an analysis of their data stratified by age, all five age groups showed a higher relative risk for Down’s syndrome in diabetic mothers; (2) Down’s syndrome should be added to the list of congenital anomalies known to occur more frequently in infants of diabetic mothers.
Table 2 in their paper does not fully support their hypothesis. As can be seen from their data, age is a confounding factor for gestational diabetes …