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GLUCOSE CONTROL AND SPONTANEOUS ABORTION IN DIABETICS.

Before the discovery of insulin, pregnancy often took the lives of both fetus and diabetic mother. With insulin therapy, maternal mortality dropped, but fetal mortality has remained a problem. Mills and colleagues report the results of the Diabetes in Early Pregnancy study, the largest prospective study of this issue ever conducted. Diabetic women in the first trimester were compared with nondiabetic women. Overall, the diabetic women, most of whom had good glucose control, had rates of spontaneous abortion similar to those of the nondiabetic women, about 16 percent. However, the small group of diabetic women with poor glucose control had significantly higher rates of spontaneous abortion. Each increase in glycosylated hemoglobin of one standard deviation above the normal range was associated with a 3.1 percent increase in the rate of spontaneous abortion.

Experiments in animals suggest that disturbances in the levels of glucose and other energy sources during the early stages of pregnancy can affect the developing fetus. If the disturbances are severe, fetal death may occur; if they are mild, congenital malformations may occur. This clinical study supports that theory.

— ALK

Published in Journal Watch General Medicine December 30, 1988

Citation(s):

Coustan DR. Pregnancy in diabetic women. N Engl J Med 1988 Dec 22 319 1663-1665.

• Medline abstract (Free)

Mills JL et al. Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception. N Engl J Med 1988 Dec 22 319 1617-1623.

• Medline abstract (Free)