The commonest congenital anomaly seen in pregnancy with diabetes mellitus is:

Ans. is c, i.e. Neural tube defectRef Fernando Arias 3/e, p 454; COGDT 10/e, p 312; Sheila Balakrishnan, p 288; Wiilliams Obs. 21/e, p 1369Friends, this is one of the most frequently asked and most controversial topic of PGMEE Exams.I am giving you all the information I could lay my hands and the rest is up to you.Congenital malformation in Diabetes: --Fernando Arias 3/e, p 454"The most frequent abnormalities involve the heart and the central nervous system. Most common are anencephaly, spina bifida, transposition of the great vessels, and ventricular septal defects"."The lesion classically associated with diabetic embryopathy, the 'caudal regression syndrome', is rare, with an incidence of 1.3 per 1000 diabetic pregnancies". --Fernando Arias 3/e, p 454Most common Anomalies in Infants of Diabetic mothers:Central nervous systemHeart and great vesselsSkeletal and spinal systemGenitourinary systemGastrointestinal systemAnencephalyHoloprosencephalyEncephaloceleTransposition of the great vesselsVentricular septal defectAortic coarctationAtrial septal defectCaudalregressionsyndromeRenal agenesisUreteral duplicationAnal atresiaSheila Balakrishnan p 288 says --Cardiac defects are the commonest (transposition of great vessels and VSD).Neural tube defects like anencephaly and spina bifida.Caudal regression syndrome or sacral agenesis, which is very rare, is the congenital defect which is specific to diabetes."The most common single-organ system anomalies were cardiac (38%), musculoskeletal (15%) and central nervous system (10%)" --Williams Obs. 21/e, p 1369Remember:Most common system involved = Cardiovascular system.IInd most common system involved = Nervous systemMost common anomalies = VSD, ASD, TGA, Anencephaly, spina bifidaIn cardiac anomalies M/C is VSD but most specific is TGA.Anomaly most specific for gestational diabetes - Caudal regression syndrome/sacral agenesis.Congenital anomalies are seen in overt diabetes and not gestational diabetesInvestigation of choice to predict the risk of congenital anomalies in diabetic patients-HbA1CInvestigation of choice to detect the risk of congenital anomalies in diabetic patients-USG