title: VACTERL association and maternal diabetes: a possible causal relationship?
abstract: BACKGROUND
  Some factors(s)/features(s) of maternal insulin-dependent diabetes mellitus are considered common human teratogens. Although the variable association of cardiac, renal, and skeletal anomalies are commonly observed in infants from diabetic mothers, the relationship between VACTERL (i.e., the association of vertebral and cardiac defects, tracheo-esophageal fistula, renal/radial malformations, and other limb anomalies) and maternal diabetes has not been sufficiently emphasized in the literature.
  
  
  METHODS
  We report on a 3-year-old boy presenting with a constellation of blastogenetic malformations strongly suggestive of VACTERL association. His mother was affected by insulin-dependent diabetes since she was 7 years old and pregnancy history disclosed very high glucose and HbA1c levels, especially during the first 2 gestational months.
  
  
  CONCLUSIONS
  In an attempt to properly counsel the parents, we reviewed the literature and identified four additional patients with VACTERL and first trimester exposure to maternal diabetes mellitus. Although this evidence does not strongly support a causal relationship between these two conditions, additional arguments may substantiate this hypothesis. The pathogenesis of diabetic embryopathy in relation to the VACTERL phenotype is also discussed.
authors.affiliation: Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy. m.castori@idi.it
authors.forename: Marco
authors.initials: M
authors.lastname: Castori
authors.forename: Rosanna
authors.initials: R
authors.lastname: Rinaldi
authors.forename: Paolo
authors.initials: P
authors.lastname: Capocaccia
authors.forename: Mario
authors.initials: M
authors.lastname: Roggini
authors.forename: Paola
authors.initials: P
authors.lastname: Grammatico
mesh_terms: D000015:Abnormalities, Multiple; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D013577:Syndrome